Science.gov

Sample records for pediatrics shows cma

  1. CMA Member Survey: Network Management Systems Showing Little Improvement.

    ERIC Educational Resources Information Center

    Lusa, John M.

    1998-01-01

    Discusses results of a survey of 112 network and telecom managers--members of the Communications Managers Association (CMA)--to identify problems relating to the operation of large enterprise networks. Results are presented in a table under categories of: respondent profile; network management systems; carrier management; enterprise management;…

  2. CMA Member Survey: Network Management Systems Showing Little Improvement.

    ERIC Educational Resources Information Center

    Lusa, John M.

    1998-01-01

    Discusses results of a survey of 112 network and telecom managers--members of the Communications Managers Association (CMA)--to identify problems relating to the operation of large enterprise networks. Results are presented in a table under categories of: respondent profile; network management systems; carrier management; enterprise management;…

  3. Clinical Utility of a Comprehensive, Whole Genome CMA Testing Platform in Pediatrics: A Prospective Randomized Controlled Trial of Simulated Patients in Physician Practices

    PubMed Central

    Martin, Megan; DeMaria, Lisa; Florentino, Jhiedon; Paculdo, David; Vanzo, Rena; Wassman, E. Robert; Burgon, Trever

    2016-01-01

    Background Developmental disorders (DD), including autism spectrum disorder (ASD) and intellectual disability (ID), are a common group of clinical manifestations caused by a variety of genetic abnormalities. Genetic testing, including chromosomal microarray (CMA), plays an important role in diagnosing these conditions, but CMA can be limited by incomplete coverage of genetic abnormalities and lack of guidance for conditions rarely seen by treating physicians. Methods We conducted a longitudinal, randomized controlled trial investigating the impact of a higher resolution 2.8 million (MM) probe-CMA test on the quality of care delivered by practicing general pediatricians and specialists. To overcome the twin problems of finding an adequate sample size of multiple rare conditions and under/incorrect diagnoses, we used standardized simulated patients known as CPVs. Physicians, randomized into control and intervention groups, cared for the CPV pediatric patients with DD/ASD/ID. Care responses were scored against evidence-based criteria. In round one, participants could order diagnostic tests including existing CMA tests. In round two, intervention physicians could order the 2.8MM probe-CMA test. Outcome measures included overall quality of care and quality of the diagnosis and treatment plan. Results Physicians ordering CMA testing had 5.43% (p<0.001) higher overall quality scores than those who did not. Intervention physicians ordering the 2.8MM probe-CMA test had 7.20% (p<0.001) higher overall quality scores. Use of the 2.8MM probe-CMA test led to a 10.9% (p<0.001) improvement in the diagnosis and treatment score. Introduction of the 2.8MM probe-CMA test led to significant improvements in condition-specific interventions including an 8.3% (p = 0.04) improvement in evaluation and therapy for gross motor delays caused by Hunter syndrome, a 27.5% (p = 0.03) increase in early cognitive intervention for FOXG1-related disorder, and an 18.2% (p<0.001) improvement in

  4. Clinical Utility of a Comprehensive, Whole Genome CMA Testing Platform in Pediatrics: A Prospective Randomized Controlled Trial of Simulated Patients in Physician Practices.

    PubMed

    Peabody, John; Martin, Megan; DeMaria, Lisa; Florentino, Jhiedon; Paculdo, David; Paul, Michael; Vanzo, Rena; Wassman, E Robert; Burgon, Trever

    2016-01-01

    Developmental disorders (DD), including autism spectrum disorder (ASD) and intellectual disability (ID), are a common group of clinical manifestations caused by a variety of genetic abnormalities. Genetic testing, including chromosomal microarray (CMA), plays an important role in diagnosing these conditions, but CMA can be limited by incomplete coverage of genetic abnormalities and lack of guidance for conditions rarely seen by treating physicians. We conducted a longitudinal, randomized controlled trial investigating the impact of a higher resolution 2.8 million (MM) probe-CMA test on the quality of care delivered by practicing general pediatricians and specialists. To overcome the twin problems of finding an adequate sample size of multiple rare conditions and under/incorrect diagnoses, we used standardized simulated patients known as CPVs. Physicians, randomized into control and intervention groups, cared for the CPV pediatric patients with DD/ASD/ID. Care responses were scored against evidence-based criteria. In round one, participants could order diagnostic tests including existing CMA tests. In round two, intervention physicians could order the 2.8MM probe-CMA test. Outcome measures included overall quality of care and quality of the diagnosis and treatment plan. Physicians ordering CMA testing had 5.43% (p<0.001) higher overall quality scores than those who did not. Intervention physicians ordering the 2.8MM probe-CMA test had 7.20% (p<0.001) higher overall quality scores. Use of the 2.8MM probe-CMA test led to a 10.9% (p<0.001) improvement in the diagnosis and treatment score. Introduction of the 2.8MM probe-CMA test led to significant improvements in condition-specific interventions including an 8.3% (p = 0.04) improvement in evaluation and therapy for gross motor delays caused by Hunter syndrome, a 27.5% (p = 0.03) increase in early cognitive intervention for FOXG1-related disorder, and an 18.2% (p<0.001) improvement in referrals to child neurology for

  5. Characterization of CmaA, an Adenylation-Thiolation Didomain Enzyme Involved in the Biosynthesis of Coronatine

    PubMed Central

    Couch, Robin; O'Connor, Sarah E.; Seidle, Heather; Walsh, Christopher T.; Parry, Ronald

    2004-01-01

    Several pathovars of Pseudomonas syringae produce the phytotoxin coronatine (COR), which contains an unusual amino acid, the 1-amino-2-ethylcyclopropane carboxylic acid called coronamic acid (CMA), which is covalently linked to a polyketide-derived carboxylic acid, coronafacic acid, by an amide bond. The region of the COR biosynthetic gene cluster proposed to be responsible for CMA biosynthesis was resequenced, and errors in previously deposited cmaA sequences were corrected. These efforts allowed overproduction of P. syringae pv. glycinea PG4180 CmaA in P. syringae pv. syringae FF5 as a FLAG-tagged protein and overproduction of P. syringae pv. tomato CmaA in Escherichia coli as a His-tagged protein; both proteins were in an enzymatically active form. Sequence analysis of CmaA indicated that there were two domains, an adenylation domain (A domain) and a thiolation domain (T domain). ATP-32PPi exchange assays showed that the A domain of CmaA catalyzes the conversion of branched-chain l-amino acids and ATP into the corresponding aminoacyl-AMP derivatives, with a kinetic preference for l-allo-isoleucine. Additional experiments demonstrated that the T domain of CmaA, which is posttranslationally modified with a 4′-phosphopantetheinyl group, reacts with the AMP derivative of l-allo-isoleucine to produce an aminoacyl thiolester intermediate. This covalent species was detected by incubating CmaA with ATP and l-[G-3H]allo-isoleucine, followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. It is postulated that the l-allo-isoleucine covalently tethered to CmaA serves as the substrate for additional enzymes in the CMA biosynthetic pathway that catalyze cyclopropane ring formation, which is followed by thiolester hydrolysis, yielding free CMA. The availability of catalytically active CmaA should facilitate elucidation of the details of the subsequent steps in the formation of this novel cyclopropyl amino acid. PMID:14679222

  6. Characterization of CmaA, an adenylation-thiolation didomain enzyme involved in the biosynthesis of coronatine.

    PubMed

    Couch, Robin; O'Connor, Sarah E; Seidle, Heather; Walsh, Christopher T; Parry, Ronald

    2004-01-01

    Several pathovars of Pseudomonas syringae produce the phytotoxin coronatine (COR), which contains an unusual amino acid, the 1-amino-2-ethylcyclopropane carboxylic acid called coronamic acid (CMA), which is covalently linked to a polyketide-derived carboxylic acid, coronafacic acid, by an amide bond. The region of the COR biosynthetic gene cluster proposed to be responsible for CMA biosynthesis was resequenced, and errors in previously deposited cmaA sequences were corrected. These efforts allowed overproduction of P. syringae pv. glycinea PG4180 CmaA in P. syringae pv. syringae FF5 as a FLAG-tagged protein and overproduction of P. syringae pv. tomato CmaA in Escherichia coli as a His-tagged protein; both proteins were in an enzymatically active form. Sequence analysis of CmaA indicated that there were two domains, an adenylation domain (A domain) and a thiolation domain (T domain). ATP-(32)PP(i) exchange assays showed that the A domain of CmaA catalyzes the conversion of branched-chain L-amino acids and ATP into the corresponding aminoacyl-AMP derivatives, with a kinetic preference for L-allo-isoleucine. Additional experiments demonstrated that the T domain of CmaA, which is posttranslationally modified with a 4'-phosphopantetheinyl group, reacts with the AMP derivative of L-allo-isoleucine to produce an aminoacyl thiolester intermediate. This covalent species was detected by incubating CmaA with ATP and L-[G-(3)H]allo-isoleucine, followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. It is postulated that the L-allo-isoleucine covalently tethered to CmaA serves as the substrate for additional enzymes in the CMA biosynthetic pathway that catalyze cyclopropane ring formation, which is followed by thiolester hydrolysis, yielding free CMA. The availability of catalytically active CmaA should facilitate elucidation of the details of the subsequent steps in the formation of this novel cyclopropyl amino acid.

  7. Radio Continuum Emission from FS CMa Stars

    NASA Astrophysics Data System (ADS)

    Rodríguez, L. F.; Báez-Rubio, A.; Miroshnichenko, A. S.

    2012-04-01

    The FS CMa stars exhibit bright optical emission-line spectra and strong IR excesses. Very little is known of their radio characteristics. We analyzed archive Very Large Array data to search for radio continuum emission in a sample of them. There are good quality data for seven of the ~40 known FS CMa stars. Of these seven stars, five turn out to have associated radio emission. Two of these stars, CI Cam and MWC 300, have been previously reported in the literature as radio emitters. We present and briefly discuss the radio detection of the other three sources: FS CMa (the prototype of the class), AS 381, and MWC 922. The radio emission is most probably of a free-free nature but additional observations are required to better characterize it.

  8. Maser observation in VY CMa with VERA

    NASA Astrophysics Data System (ADS)

    Choi, Yoon Kyung

    We present the results of multi-epoch VERA (VLBI Exploration of Radio Astrometry) observations of H2O masers at 22 GHz and ^28SiO masers at 43 GHz in the supergiant VY Canis Majoris (hereafter, VY CMa). We estimate the inner motion of H2O masers over 6 months and that of SiO masers over 1 month. Using the inner motion, we calculated the statistical parallax of VY CMa. The size of the emitting region for ^28SiO masers is R_SiO ~1.81-2.89 R_* and it is consistent with the previous study.

  9. Correlation between sperm DNA fragmentation index and CMA3 positive spermatozoa in globozoospermic patients.

    PubMed

    Hosseinifar, H; Yazdanikhah, S; Modarresi, T; Totonchi, M; Sadighi Gilani, M A; Sabbaghian, M

    2015-05-01

    The absence of the acrosome causes the situation which is called globozoospermia. There are a few studies, mostly as case reports, about correlation between levels of sperm DNA damage in patients with total round-headed spermatozoa. We investigated this correlation as well as CMA3 positive spermatozoa in 20 globozoospermic men (with more than 90% round-headed spermatozoa) attending to Royan Institute. Semen samples divided into three parts to semen analysis, to measure DNA fragmentation index (DFI) using sperm chromatin structure assay (SCSA) and to detect CMA3(+) sperm cells by chromomycin A3 staining and fluorescent microscopy. Our results showed that there were significant differences in sperm concentration, total sperm motility, and normal morphology between patients and controls group (p < 0.001). Moreover, the average of DFI and CMA3 positive spermatozoa in patients group significantly increases compared with control group (p < 0.001). A significant correlation between DFI and CMA3(+) in total population was also detected in patients group (r = 0.45, p = 0.046). To our knowledge, this is the largest study about correlation between DNA damage levels and CMA3 positive spermatozoa with round head sperm cells in total globozoospermic men. It seems that the increase in DNA damage may be because of defective sperm DNA compaction, as we detected CMA3 positive sperm cells in these patients.

  10. Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens.

    PubMed

    Shea, Kevin G; Milewski, Matthew D; Cannamela, Peter C; Ganley, Theodore J; Fabricant, Peter D; Terhune, Elizabeth B; Styhl, Alexandra C; Anderson, Allen F; Polousky, John D

    2017-06-01

    Anterior cruciate ligament (ACL) reconstruction failure rates are highest in youth athletes. The role of the anterolateral ligament in rotational knee stability is of increasing interest, and several centers are exploring combined ACL and anterolateral ligament reconstruction for these young patients. Literature on the anterolateral ligament of the knee is sparse in regard to the pediatric population. A single study on specimens younger than age 5 years demonstrated the presence of the anterolateral ligament in only one of eight specimens; therefore, much about the prevalence and anatomy of the anterolateral ligament in pediatric specimens remains unknown. We sought to (1) investigate the presence or absence of the anterolateral ligament in prepubescent anatomic specimens; (2) describe the anatomic relationship of the anterolateral ligament to the lateral collateral ligament; and (3) describe the anatomic relationship between the anterolateral ligament and the physis. Fourteen skeletally immature knee specimens (median age, 8 years; range, 7-11 years) were dissected (12 male, two female specimens). The posterolateral structures were identified in all specimens, including the lateral collateral ligament and popliteus tendon. The presence or absence of the anterolateral ligament was documented in each specimen, along with origin, insertion, and dimensions, when applicable. The relationship of the anterolateral ligament origin to the lateral collateral ligament origin was recorded. The anterolateral ligament was identified in nine of 14 specimens. The tibial attachment point was consistently located in the same region on the proximal tibia, between the fibular head and Gerdy's tubercle; however, the femoral origin of the anterolateral ligament showed considerable variation with respect to the lateral collateral ligament origin. The median femoral origin of the anterolateral ligament was 10 mm (first interquartile 6 mm, third interquartile 13) distal to the distal

  11. The X-ray binary, UW CMa

    NASA Technical Reports Server (NTRS)

    Heap, S. R.

    1982-01-01

    The UW CMa is a close, eclipsing binary composed of an O7f primary with a stron wind and a less luminous O-type companion. It was found that UW CMa a variable X-ray source, whose X-ray variations are in phase with its optical light curve. Since both components of the binary system are O stars, accretion by a compact object is ruled out as a mechanism for generating X-rays. The UW CMa represents a new class of X-ray binaries, in which X-rays result from the collision of a wind from one star with the surface or wind of the other star. It is hypothesised that the impact of a wind against a star generates a shock wave about 0.25 stellar radii above the stellar surface, and material behind the shock front, heated to bout 10 million degrees, radiates the X-ray apparent X-ray variability is due to its location between the two stars, where it undergoes eclipses. The high temperature region maintains an ionization cavity in the wind, as detected with IUE. The ionization cavity is the source of depletion of absorbing ions in the wind between the two stars.

  12. Carboplatin Hypersensitivity Reactions in Pediatric Low Grade Glioma Are Protocol Specific and Desensitization Shows Poor Efficacy.

    PubMed

    Dodgshun, Andrew J; Hansford, Jordan R; Cole, Theresa; Choo, Sharon; Sullivan, Michael J

    2016-01-01

    The use of carboplatin for the treatment of pediatric low grade gliomas (PLGG) is often limited by the development of carboplatin hypersensitivity. Reported rates of carboplatin hypersensitivity reactions vary between 6% and 32% in these patients. Here we report the frequency of carboplatin hypersensitivity reactions depending on the treatment regimen used, and outcomes of carboplatin desensitization. The records of all patients in a single institution who were treated with carboplatin for PLGG were accessed and all patients receiving more than one dose of carboplatin are reported. Thirty four patients with PLGG were treated with carboplatin according to one of the two different regimens. Carboplatin hypersensitivity was documented in 47% of patients, but the frequency differed by treatment protocol. Those patients treated with 4-weekly single agent carboplatin had carboplatin allergy in 8% of cases whereas 68% of those treated with combined carboplatin and vincristine (every three weeks, according to the SIOP 2004 low grade glioma protocol) had carboplatin reactions (OR 23.6, P < 0.01). Desensitization was only successful in two out of 10 patients in whom it was attempted. Hypersensitivity reactions to carboplatin are more common in this cohort than previously reported and rates are protocol-dependent. Desensitization showed limited effectiveness in this cohort. © 2015 Wiley Periodicals, Inc.

  13. Degenerative changes of the corticospinal tract in pediatric patients showing deteriorated motor function: A diffusion tensor tractography study.

    PubMed

    Chang, Min Cheol; Jang, Sung Ho; Seo, Jeong Pyo; Lee, Eusil; Kim, Saeyoon; Won, Yu Hui; Son, Su Min

    2015-01-01

    We attempted to demonstrate the corresponding degenerative changes of the affected corticospinal tract (CST) in pediatric patients with deteriorated motor function using diffusion tensor tractography (DTT). We recruited three pediatric patients (corrected age: 2, 6 and 47 months, respectively) who showed impaired motor function. DTT in each patient showed interruption of the CSTs of the hemisphere contralateral to the side of motor impairment. Despite motor impairment and abnormal DTT findings, none of the three patients received rehabilitative therapy. The patients (corrected age: 9, 53 and 59 months, respectively) and their parents visited our clinic again due to deterioration of motor functions. Follow-up DTT of all evaluated patients showed significant degenerative changes in the affected CSTs in accordance with the aggravation of motor impairment. We presented degenerative changes of the affected CSTs in pediatric patients according to the deterioration of motor function.

  14. Ethical problems in pediatrics: what does the setting of care and education show us?

    PubMed

    Guedert, Jucélia Maria; Grosseman, Suely

    2012-03-16

    Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity. 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors. Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics. This research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review Committee (Report CEP-HIJG 032/2008).

  15. Sun signs Valdez Principles; rejoining CMA

    SciTech Connect

    Kirschner, E.

    1993-02-17

    Four year after an investors' group developed the Valdez Principles in response to the Exxon oil spill, Sun Co. (Philadelphia) has become the first major corporation to sign on to the environmental commitment. Sun also says it plans to rejoin the Chemical Manufacturers Association (CMA) in light of new emphasis on its chemical business and to recommit to the Responsible Care program. Sun negotiated the commitment's working with the Coalition for Economically Responsible Economies (CERES; New York), which devised the code of conduct, now called the CERES Principles. It requries goals of reducing environmental impact, as well as annual environmental auditing and public reporting of results. Annual environmental reporting is coming,' says Sun chairman and CEO Robert H. Campbell. CERES' report provides credibility and accountability, he says. Sun's signing is the onset of a stampede,' says New York City Comptroller Elizabeth Holtzman, who advises on investment of the city's $47-billion pension funds. CERES says that between tens of' Fortune 500 companies have shown interest in a negotiated code. The 50 other signers are smaller companies. Du Pont says it is waiting to see Sun's agreement. Campbell says the commitment complements Sun's five-year-old program, which incorporates the American Petroleum Institute program and CMA's Responsible Care initiative. I don't think anything will change that the customer will notice,' he adds.

  16. Task Control Signals in Pediatric Tourette Syndrome Show Evidence of Immature and Anomalous Functional Activity

    PubMed Central

    Church, Jessica A.; Wenger, Kristin K.; Dosenbach, Nico U. F.; Miezin, Francis M.; Petersen, Steven E.; Schlaggar, Bradley L.

    2009-01-01

    Tourette Syndrome (TS) is a pediatric movement disorder that may affect control signaling in the brain. Previous work has proposed a dual-networks architecture of control processing involving a task-maintenance network and an adaptive control network (Dosenbach et al., 2008). A prior resting-state functional connectivity MRI (rs-fcMRI) analysis in TS has revealed functional immaturity in both putative control networks, with “anomalous” correlations (i.e., correlations outside the typical developmental range) limited to the adaptive control network (Church et al., 2009). The present study used functional MRI (fMRI) to study brain activity related to adaptive control (by studying start-cues signals), and to task-maintenance (by studying signals sustained across a task set). Two hypotheses from the previous rs-fcMRI results were tested. First, adaptive control (i.e., start-cue) activity will be altered in TS, including activity inconsistent with typical development (“anomalous”). Second, group differences found in task-maintenance (i.e., sustained) activity will be consistent with functional immaturity in TS. We examined regions found through a direct comparison of adolescents with and without TS, as well as regions derived from a previous investigation that showed differences between unaffected children and adults. The TS group showed decreased start-cue signal magnitude in regions where start-cue activity is unchanged over typical development, consistent with anomalous adaptive control. The TS group also had higher magnitude sustained signals in frontal cortex regions that overlapped with regions showing differences over typical development, consistent with immature task-maintenance in TS. The results demonstrate task-related fMRI signal differences anticipated by the atypical functional connectivity found previously in adolescents with TS, strengthening the evidence for functional immaturity and anomalous signaling in control networks in adolescents with TS

  17. Effects of water and CMA in mitigating industrial road dust resuspension

    NASA Astrophysics Data System (ADS)

    Amato, Fulvio; Escrig, Alberto; Sanfelix, Vicenta; Celades, Irina; Reche, Cristina; Monfort, Eliseo; Querol, Xavier

    2016-04-01

    Water spraying and/or chemical suppressants such as salts and polymers have been suggested to reduce road dust resuspension due to their capability to increase adhesion, and therefore the effective size and weight of particles, but contrasting results have been obtained so further testing are needed. This study presents the first results of street washing and Calcium Magnesium Acetate (CMA) efficiencies at two industrial roads (paved and unpaved) in the Mediterranean region where the high solar radiation, warm climate, and scarce precipitation, may play a key role in determining the efficiency of mitigation techniques Results show that, at both sites, street washing (water only) was more effective than CMA. Street washing made observe 18% (daily basis) and >90% (first hour) reductions of kerbside PM10 concentrations for the paved and unpaved road respectively, while with CMA PM10 decrease was generally lower and with less statistical significance.

  18. On the Binary Origin of FS CMa Stars: Young Massive Clusters as Test Beds

    NASA Astrophysics Data System (ADS)

    de la Fuente, D.; Najarro, F.; Garcia, M.

    2017-02-01

    FS CMa stars are low-luminosity objects showing the B[e] phenomenon whose evolutionary origin is yet to be unraveled. Various binary-related hypotheses have been recently proposed, two of them involving a spiral-in evolution of the binary orbit. The latter occurs more often in dense stellar environments, such as young massive clusters (YMCs). Hence, a systematic study of FS CMa stars in YMCs would be crucial to find out how these objects are created. Two FS CMa stars have been confirmed and three candidates have been found in YMCs through a search method based on narrow-band photometry at Paschen-α and the neighboring continuum. We apply this method to archival data from the Paschen-α survey of the Galactic Center region, yielding a new candidate in the Quintuplet cluster. Limitations of this method and other alternatives are briefly discussed.

  19. Evaluation of Effect of CMA Radius on SOQPSK Equalization

    DTIC Science & Technology

    2014-06-23

    the International Telemetry Conference ( ITC ) 2004, San Diego, CA. [3] A.Cole-Rhodes, H. Umuolo, F. Moazzami, M. Rice, “Real-Time CMA Equalization...of SOQPSK for Aeronautical Telemetry”, submitted to ITC 2014. [4] A.Cole-Rhodes, H. Umuolo, F. Moazzami, M. Rice, “A Block Processing Approach to CMA

  20. Neurocognitive Function in Pediatric Bipolar Disorder: 3-Year Follow-Up Shows Cognitive Development Lagging behind Healthy Youths

    ERIC Educational Resources Information Center

    Pavuluri, Mani N.; West, Amy; Hill, Kristian; Jindal, Kittu; Sweeney, John A.

    2009-01-01

    The comparison of the neurocognitive functioning of people with pediatric bipolar disorder (PBD) with a control group shows that the developmental progress in executive functions and verbal memory of those with PBD was significantly less than those in the control group. The results were seen after comparing data from baseline cognitive tests and a…

  1. Neurocognitive Function in Pediatric Bipolar Disorder: 3-Year Follow-Up Shows Cognitive Development Lagging behind Healthy Youths

    ERIC Educational Resources Information Center

    Pavuluri, Mani N.; West, Amy; Hill, Kristian; Jindal, Kittu; Sweeney, John A.

    2009-01-01

    The comparison of the neurocognitive functioning of people with pediatric bipolar disorder (PBD) with a control group shows that the developmental progress in executive functions and verbal memory of those with PBD was significantly less than those in the control group. The results were seen after comparing data from baseline cognitive tests and a…

  2. Progesterone Treatment Shows Benefit in a Pediatric Model of Moderate to Severe Bilateral Brain Injury

    PubMed Central

    Geddes, Rastafa I.; Sribnick, Eric A.; Sayeed, Iqbal; Stein, Donald G.

    2014-01-01

    Purpose Controlled cortical impact (CCI) models in adult and aged Sprague-Dawley (SD) rats have been used extensively to study medial prefrontal cortex (mPFC) injury and the effects of post-injury progesterone treatment, but the hormone's effects after traumatic brain injury (TBI) in juvenile animals have not been determined. In the present proof-of-concept study we investigated whether progesterone had neuroprotective effects in a pediatric model of moderate to severe bilateral brain injury. Methods Twenty-eight-day old (PND 28) male Sprague Dawley rats received sham (n = 24) or CCI (n = 47) injury and were given progesterone (4, 8, or 16 mg/kg per 100 g body weight) or vehicle injections on post-injury days (PID) 1–7, subjected to behavioral testing from PID 9–27, and analyzed for lesion size at PID 28. Results The 8 and 16 mg/kg doses of progesterone were observed to be most beneficial in reducing the effect of CCI on lesion size and behavior in PND 28 male SD rats. Conclusion Our findings suggest that a midline CCI injury to the frontal cortex will reliably produce a moderate TBI comparable to what is seen in the adult male rat and that progesterone can ameliorate the injury-induced deficits. PMID:24489882

  3. Pediatrics

    NASA Technical Reports Server (NTRS)

    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.

  4. Are B[e] Stars of FS CMa-Type Related to Double Periodic Variables?

    NASA Astrophysics Data System (ADS)

    Mennickent, R.

    2017-02-01

    We have recently examined the relation between two types of intermediate-mass interacting binaries; the strongly interacting W Serpentis stars and the enigmatic double periodic variables (DPVs). In both cases, the analysis of WISE and 2MASS photometry indicates the presence of color excess that might be attributed to circumstellar matter. This is supported by the presence of Balmer emission lines and by the light curve models. However, W Serpentis stars are sometimes less massive than DPVs and usually show changes in their orbital periods. In this contribution, a third type of object has been examined, the B[e] stars of the FS CMa type, of which 30% have been found to be binaries. They are located in a similar region of the HR diagram to DPVs, but show stronger emission lines and larger color excess. Since theoretical models indicate that all these close binaries pass by epochs of strong mass loss, at least some of the FS CMa systems might be precursors of DPVs, closer to the stage of mass ratio reversal. Fundamental stellar parameters for FS CMa stars are still scarce; more studies are needed, especially spectroscopic ones, to clarify this possibility.

  5. Preliminary comparison of the CMA, ECMWF, NCEP, and JMA ensemble prediction systems

    NASA Astrophysics Data System (ADS)

    Duan, Mingkeng; Ma, Juhui; Wang, Panxing

    2012-02-01

    Based on The Observing System Research and Predictability Experiment (THORPEX) Interactive Grand Global Ensemble (TIGGE) dataset, using various verification methods, the performances of four typical ensemble prediction systems (EPSs) from the China Meteorological Administration (CMA), the European Centre for Medium-Range Weather Forecasts (ECMWF), the US National Centers for Environmental Prediction (NCEP), and the Japan Meteorological Agency (JMA) are compared preliminarily. The verification focuses on the 500-hPa geopotential height forecast fields in the mid- and high-latitude Eurasian region during July 2007 and January 2008. The results show that for the forecast of 500-hPa geopotential height, in both summer and winter, the ECMWF EPS exhibits the highest forecast skill, followed by that of NCEP, then by JMA, and the CMA EPS gets in the last. The better system behaviors benefit from the better combination of the following: data assimilation system, numerical models, initial perturbations, and stochastic model perturbations. For the medium-range forecast, the ensemble forecasting can effectively filter out the forecast errors associated with the initial uncertainty, and the reliability and resolution (the two basic attributions of the forecast system) of these EPSs are better in winter than in summer. Specifically, the CMA EPS has certain advantage on the reliability of ensemble probabilistic forecasts. The forecasts are easy to be underestimated by the JMA EPS. The deficiency of ensemble spread, which is the universal problem of EPS, also turns up in this study. Although the systems of ECMWF, NCEP, and JMA have more ensemble members, this problem cannot be ignored. This preliminary comparison helps to further recognize the prediction capability of the four EPSs over the Eurasian region, provides important references for wide applications of the TIGGE dataset, and supplies useful information for improving the CMA EPS.

  6. The evolution of CMA bands in Citrus and related genera.

    PubMed

    e Silva, Ana Emília Barros; Marques, André; dos Santos, Karla G B; Guerra, Marcelo

    2010-06-01

    Most species of Citrus and related genera display a similar karyotype with 2n = 18 and a variable number of terminal heterochromatic blocks positively stained with chromomycin A(3) (CMA(+) bands). Some of these blocks are 45S rDNA sites, whereas others may correspond to the main GC-rich satellite DNA found in several Citrus species. In the present work, the distribution of the 45S rDNA and the main satellite DNA isolated from C. sinensis (CsSat) were investigated by in situ hybridization in seven species of Citrus, two species of closely related genera (Fortunella obovata and Poncirus trifoliata) and four species of the subfamily Aurantioideae, which were less related to Citrus (Atalantia monophylla, Murraya paniculata, Severinia buxifolia, and Triphasia trifolia). In Citrus, Fortunella, and Poncirus, most CMA(+) bands colocalized only with CsSat sites, whereas others colocalized only with rDNA sites. However, some of these species displayed a few CMA(+) bands that colocalized with sites of both probes and other CMA(+) bands that did not colocalized with any of the probes. On the other hand, in the four species less related to Citrus, no CsSat signal was found on chromosomes. On Southern blot, the CsSat probe hybridized with genomic DNA from Citrus, Fortunella, and Poncirus at high stringency only, while under the less stringent conditions, it also hybridized with distantly related species. Therefore, CsSat sequences are the principal component of the heterochromatic blocks of Citrus, Poncirus, and Fortunella, whereas CsSat-like sequences seem to be widespread in the subfamily Aurantioideae. These data further suggest that the variable number of terminal CMA(+) bands observed on chromosomes of Citrus and related genera are probably the consequence of amplification or reduction in the number of CsSat-like sequences distributed on chromosome termini, paralleled by mutation and homogenization events, as proposed by the library hypothesis.

  7. Joint statement on resuscitative interventions (update 1995). CMA policy summary.

    PubMed

    1995-12-01

    This joint statement includes: guiding principles for health care facilities when developing cardiopulmonary-resuscitation (CPR) policy; CPR as a treatment option; competence; the treatment decision, its communication, implementation and review; and palliative care and other treatment. This joint statement was approved by the Canadian Healthcare Association, the CMA, the Canadian Nurses Association and the Catholic Health Association of Canada and was developed in cooperation with the Canadian Bar Association.

  8. New outburst of the young binary system Z CMa

    NASA Astrophysics Data System (ADS)

    Maehara, Hiroyuki; Ukita, Nobuharu

    2015-01-01

    We report the detection of a new outburst of Z CMa. According to the photometric data from the Kamogata-Kiso-Kyoto Wide-field Survey (KWS; f.l.=105mm lens + SBIG ST-8XME CCD Camera) database, V- and Ic-band fluxes of the object have gradually increased since around 2014 December 13, and reached 9.6 mag in V-band and 8.2 mag in Ic-band on 2015 January 02.641.

  9. Evaluating CMA Equalization of SOQPSK-TG for Aeronautical Telemetry

    DTIC Science & Technology

    2015-03-01

    Aeronautical Telemetry March 2015 DISTRIBUTION STATEMENT A. Approved for public release: distribution unlimited. Test Resource Management...Equalization of SOQPK-TG Data for Aeronautical Telemetry 5a. CONTRACT NUMBER: W900KK-13-C-0026 5b. GRANT NUMBER: N/A 5c. PROGRAM ELEMENT NUMBER 6...This standard is defined and used for aeronautical telemetry. Based on the iNET-packet structure, the adaptive block processing CMA equalizer can be

  10. Real-Time CMA Equalization of SOQPSK for Aeronautical Telemetry

    DTIC Science & Technology

    2014-06-01

    Telemetry Conference ( ITC ) 2004, San Diego, CA. [3] A.Cole-Rhodes, H. Umuolo, F. Moazzami, M. Rice, “A Block Processing Approach to CMA Equalization...Systems, vol. 49, no. 4, pp. 2340–2352, October 2013. [7] M. Rice, M. Saquib, M.S. Afran, A.Cole-Rhodes, F. Moazzami, “A Comparison of Three Equalization Techniques for iNET-formatted SOQPSK-TG”, submitted to ITC 2014.

  11. The pulsating magnetosphere of the extremely slowly rotating magnetic β Cep star ξ1 CMa

    NASA Astrophysics Data System (ADS)

    Shultz, M.; Wade, G. A.; Rivinius, Th.; Neiner, C.; Henrichs, H.; Marcolino, W.; MiMeS Collaboration

    2017-10-01

    ξ1 CMa is a monoperiodically pulsating, magnetic β Cep star with magnetospheric X-ray emission that, uniquely amongst magnetic stars, is clearly modulated with the star's pulsation period. The rotational period Prot has yet to be identified, with multiple competing claims in the literature. We present an analysis of a large ESPaDOnS data set with a 9 yr baseline. The longitudinal magnetic field 〈Bz〉 shows a significant annual variation, suggesting that Prot is at least of the order of decades. The possibility that the star's H α emission originates around a classical Be companion star is explored and rejected based upon Very Large Telescope Interferometer AMBER and PIONIER interferometry, indicating that the emission must instead originate in the star's magnetosphere and should therefore also be modulated with Prot. Period analysis of H α equivalent widths measured from ESPaDOnS and CORALIE spectra indicates Prot > 30 yr. All evidence thus supports that ξ1 CMa is a very slowly rotating magnetic star hosting a dynamical magnetosphere. H α also shows evidence for modulation with the pulsation period, a phenomenon that we show cannot be explained by variability of the underlying photospheric line profile, i.e. it may reflect changes in the quantity and distribution of magnetically confined plasma in the circumstellar environment. In comparison to other magnetic stars with similar stellar properties, ξ1 CMa is by far the most slowly rotating magnetic B-type star, is the only slowly rotating B-type star with a magnetosphere detectable in H α (and thus, the coolest star with an optically detectable dynamical magnetosphere), and is the only known early-type magnetic star with H α emission modulated by both pulsation and rotation.

  12. Patients with pediatric obstructive sleep apnea show altered T-cell populations with a dominant TH17 profile.

    PubMed

    Anderson, Martin E; Buchwald, Zachary S; Ko, Je; Aurora, Rajeev; Sanford, Thomas

    2014-05-01

    To characterize the immunologic changes of the tonsil as they correlate with increasing apnea-hypopnea index (AHI) in children. Prospective immunologic analysis. Tertiary care pediatric otolaryngology practice. Tonsils were collected from 24 children with obstructive sleep apnea, all of whom had undergone polysomnography at an accredited sleep center using scoring determined by the American Academy of Sleep Medicine 2007 scoring manual. Patients were excluded if they had been diagnosed with craniofacial abnormalities, neuromuscular disorders, or immunodeficiency. Single-cell suspensions were isolated from tonsils of 13 individuals and stained with fluor-conjugated antibodies and analyzed using fluorescence-activated cell sorting. Single-cell suspensions from tonsils of 11 additional individuals were incubated 21 hours and subjected to multiplexed enzyme-linked immunosorbent assay cytokine analysis. In patients with an AHI >5 events/h, there was a statistically significant increase in the fraction of CD4(+) CD45RO(+) T cells (P < .01), and the percentage of CD8(+) FoxP3(+) T cells (TcREG) showed a statistically significant decrease (P < .005). Cytokine analysis revealed high levels of interleukin (IL)-17A, IL-1b, IL-10, and IL-12p70 production. Cytokine profiles revealed a conspicuous absence of IL-4 and IL-2. Our results indicate the tonsils of patients with obstructive sleep apnea have an ongoing inflammatory response characterized by increased effector CD4 T cells and decreased FoxP3 CD8 T cells. The TH17 skewing suggests that local immune activation may be either autoimmune or due to an extracellular pathogen.

  13. It's time for CMA to put the lid on privatization.

    PubMed Central

    Carver, C

    1996-01-01

    Family physician Cynthia Carver wasn't heartened by the CMA's "last-minute retreat" from a call to pursue privatization of health care. During its August annual meeting, the association not only supported a strong, publicly funded health care system but also passed a number of resolutions related to the private sector and the appropriate role for regulated private medical insurance in Canada. Carver proposes that the energy being expended on schemes to delist, privatize, define core services and design payment schemes should instead be applied to improving the existing system. PMID:8873642

  14. Analysis of heterochromatin by combination of C-banding and CMA3 and DAPI staining in two fish species (Pimelodidae, Siluriformes).

    PubMed

    Swarça, Ana C; Fenocchio, Alberto S; Cestari, Marta M; Dias, Ana L

    2003-09-01

    The chromosomes of Steindachneridion sp. (2n = 56) and Rhamdia quelen (2n = 58) were analyzed by C-banding (CB) and Chromomycin A3 (CMA3) and 4,6-diamidino-2-phenylindole (DAPI) staining, separately and consecutively, in order to understand the role of base-specific fluorochrome treatment after CB. Both species' chromosomes shared common staining profiles as follows. CB with Giemsa (CBG) revealed weak heterochromatic blocks in the telomeric regions of some chromosomes and conspicuous bands on the short arms of one chromosome pair, where nucleolar organizer regions (NORs) were evidenced by silver-staining. Without CB pretreatment, the NORs were stained conspicuously with CMA3, but not with DAPI. The latter uniformly stained all chromosomes, but leaving the NORs pale. Combination of CMA3 or DAPI staining with CB showed distinctive fluorescent blocks in the NOR-bearing short arms of the single chromosome pair along with several bright fluorescent signals on other chromosomes, which were not evidenced by single CMA3 or DAPI staining. These results suggest a modification of chromatin structure by CB treatment, which may increase the stainability of CMA3 and DAPI.

  15. Molecular cytogenetic analysis of the double-CMA3 chromosome of lake trout, Salvelinus namaycush.

    PubMed

    Reed, K M; Phillips, R B

    1995-01-01

    The chromosome possessing two chromomycin A3 (CMA3) staining sites in lake trout (Salvelinus namaycush) was examined using FISH. All CMA3-bands in the karyotype contained ribosomal DNA (rDNA), including both sites on the double-CMA3 chromosome. One rDNA site on this chromosome was bordered by telomeric repeats, implicating a rearrangement in the origin of the second NOR.

  16. ALMA observations of TiO2 around VY CMa

    NASA Astrophysics Data System (ADS)

    De Beck, Elvire; Vlemmings, Wouter; Muller, Sébastien; Black, John H.; O'Gorman, Eamon; Richards, Anita M. S.; Baudry, Alain; Maercker, Matthias; Decin, Leen; Humphreys, Elizabeth M.

    2016-07-01

    Titanium dioxide, TiO2, is a refractory species that could play a crucial role in the dust-condensation sequence around oxygen-rich evolved stars. We present and discuss the detections of 15 emission lines of TiO2 with ALMA in the complex environment of the red supergiant VY CMa. The observations reveal a highly clumpy, anisotropic outflow in which the TiO2 emission likely traces gas exposed to the stellar radiation field. We find evidence for a roughly east-west oriented, accelerating bipolar-like structure, of which the blue component runs into and breaks up around a solid continuum component. We see a distinct tail to the south-west for some transitions, consistent with features seen in the optical and near-infrared. We find that a significant fraction of TiO2 remains in the gas phase outside the dust-formation zone and suggest that this species might play only a minor role in the dust-condensation process around extreme oxygen-rich evolved stars like VY CMa.

  17. Spatial analysis of pediatric burns shows geographical clustering of burns and 'hotspots' of risk factors in New South Wales, Australia.

    PubMed

    Goltsman, David; Li, Zhe; Bruce, Eleanor; Connolly, Siobhan; Harvey, John G; Kennedy, Peter; Maitz, Peter K M

    2016-06-01

    Pediatric burns are a significant cause of morbidity and mortality, and it is estimated that more than 80% are preventable. Studies among adults have shown that burns risk are geographically clustered, and higher in socioeconomically-disadvantaged areas. Few studies among children have examined whether burns are geographically clustered, and if burn prevention programs are best targeted to high-risk areas. Retrospective analyses examined the 2005-to-2014 NSW Severe Burns Injury Service data. Geospatial imaging software was used to map the relative-risk and clustering of burns by postcodes in Greater Sydney Area (GSA). Cluster analyses were conducted using Getis-Ord and Global Moran's I statistics. High- and low-risk populations and areas were examined to ascertain differences by sociodemographic characteristics, etiology and the extent of the burn. Scalds were the most common types of burns and boys were at greater risk than girls. There was significant clustering of burns by postcode area, with a higher relative risk of burns in western and north-western areas of Sydney. The high-risk clusters were associated with socioeconomic disadvantage, and areas of low burns risk were associated with socioeconomic advantage. In both high- and low-risk areas burns occurred more frequently in the 12-24 months and the 24-36 months age groups. The implication of this study is that pediatric burns risk clustering occurs in specific geographic regions that are associated with socioeconomic disadvantage. The results of this study provide greater insight into how pediatric populations can be targeted when devising intervention strategies, and suggest that an area-targeted approach in socioeconomically-disadvantaged areas may reduce burns risk. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  18. THE PAN-PACIFIC PLANET SEARCH. I. A GIANT PLANET ORBITING 7 CMa

    SciTech Connect

    Wittenmyer, Robert A.; Tinney, C. G.; Endl, Michael; Wang Liang; Johnson, John Asher; O'Toole, S. J.

    2011-12-20

    We introduce the Pan-Pacific Planet Search, a survey of 170 metal-rich Southern Hemisphere subgiants using the 3.9 m Anglo-Australian Telescope. We report the first discovery from this program, a giant planet orbiting 7 CMa (HD 47205) with a period of 763 {+-} 17 days, eccentricity e = 0.14 {+-} 0.06, and msin i = 2.6 {+-} 0.6 M{sub Jup}. The host star is a K giant with a mass of 1.5 {+-} 0.3 M{sub Sun} and metallicity [Fe/H] = 0.21 {+-} 0.10. The mass and period of 7 CMa b are typical of planets which have been found to orbit intermediate-mass stars (M{sub *} > 1.3 M{sub Sun }). Hipparcos photometry shows this star to be stable to 0.0004 mag on the radial-velocity period, giving confidence that this signal can be attributed to reflex motion caused by an orbiting planet.

  19. Acetylation targets HSD17B4 for degradation via the CMA pathway in response to estrone.

    PubMed

    Zhang, Ye; Xu, Ying-Ying; Yao, Chuan-Bo; Li, Jin-Tao; Zhao, Xiang-Ning; Yang, Hong-Bin; Zhang, Min; Yin, Miao; Chen, Jing; Lei, Qun-Ying

    2017-03-04

    Dysregulation of hormone metabolism is implicated in human breast cancer. 17β-hydroxysteroid dehydrogenase type 4 (HSD17B4) catalyzes the conversion of estradiol (E2) to estrone (E1), and is associated with the pathogenesis and development of various cancers. Here we show that E1 upregulates HSD17B4 acetylation at lysine 669 (K669) and thereby promotes HSD17B4 degradation via chaperone-mediated autophagy (CMA), while a single mutation at K669 reverses the degradation and confers migratory and invasive properties to MCF7 cells upon E1 treatment. CREBBP and SIRT3 dynamically control K669 acetylation level of HSD17B4 in response to E1. More importantly, K669 acetylation is inversely correlated with HSD17B4 in human breast cancer tissues. Our study reveals a crosstalk between acetylation and CMA degradation in HSD17B4 regulation, and a critical role of the regulation in the malignant progression of breast cancer.

  20. High diversity in CMA3/DAPI-banding patterns in Heteropterans.

    PubMed

    Bardella, V B; Grazia, J; Fernandes, J A M; Vanzela, A L L

    2014-01-01

    Heteroptera is the most numerous and diverse suborder of Hemiptera, with about 38,000 species. This diversity also involves cytogenetic features, including chromosome number and a sex determining system. Information about heterochromatin occurrence and distribution is scarce in heteropterans, but still, there is some evidence of variability. We determined the chromosome number and CMA3/DAPI-banding pattern of 179 individuals of 25 heteropteran species from Brazil. Eight species of Pentatomidae exhibited a constant chromosome number (2n = 12 + XY), but in Coreidae (12 species), Largidae (1 species), Rhopalidae (1 species), and Pyrrhocoridae (3 species), the numbers ranged from 2n = 10 + 2m + X0 to 2n = 24 + 2m + X0. Although there were no large differences in the chromosome size between species, the CMA3/DAPI-banding patterns differed markedly. Among the genera, species of Edessa, Spartocera, Hypselonotus, Phtia,Holhymenia and Euryophthalmus showed a large accumulation of heterochromatin, while the other species exhibited few or no heterochromatic bands. In general, when heterochromatin was more accumulated, this occurred preferentially at terminal positions, except in Holhymenia histrio, which exhibited intercalary bands. This study made it possible to identify some chromosome rearrangements and to enhance our knowledge of the evolutionary mechanisms that determine karyotype differentiation in Heteroptera.

  1. Tacrolimus ointment 0.03% shows efficacy and safety in pediatric and adult patients with mild to moderate atopic dermatitis.

    PubMed

    Chapman, M Shane; Schachner, Lawrence A; Breneman, Debra; Boguniewicz, Mark; Gold, Michael H; Shull, Toni; Linowski, Gregory J; Jaracz, Eileen

    2005-08-01

    Tacrolimus ointment is approved for the treatment of moderate to severe atopic dermatitis (AD). We sought to evaluate the efficacy and safety of tacrolimus ointment 0.03% compared with vehicle in the treatment of patients with mild to moderate AD. Two identically designed, independent, randomized, double-blind, 6-week studies--one pediatric and one adult--in patients with mild to moderate AD were conducted. Combined data from 617 patients were used in the analysis. The primary efficacy end point was percentage of patients with treatment success (defined as "clear" or "almost clear" on the Investigator's Global AD Assessment) at end of study. As early as day 4, treatment success occurred in 17.7% of patients treated with tacrolimus compared with 9.8% of patients treated with vehicle ( P = .003), and by study end had increased to 49.7% for tacrolimus versus 29.0% for vehicle (P < .0001). Tacrolimus was associated with significantly less application site pruritus than vehicle (29.0% vs 37.5%; P = .03). There was no difference between tacrolimus and vehicle in the incidence of application site skin burning and stinging. Tacrolimus ointment 0.03% is effective and safe for the management of mild to moderate AD in both adult and pediatric patients, and has a rapid onset of action.

  2. Real-time experimental demonstration of PS-QPSK transmission with manipulated rotating and novel correlated CMA.

    PubMed

    Li, Haibo; Zeng, Tao; Li, Jie; Jiang, Feng; Liu, Ziqing; Hu, Rong; Luo, Ming; Wang, Yuanxiang; Li, Xiang; Yang, Qi; Yu, Shaohua; Huang, Liyan; Cao, Li

    2016-07-25

    In this paper, we propose a novel manipulated rotating polarization switched quadrature phase shift keying (MR-PS-QPSK) technique, and corresponding correlated constant modulus algorithm (CMA) for signal recovery. The latter utilizes the correlation between the PS-QPSK symbols in the two polarizations to lock the phase of output signals. Then the signals in the two polarizations are merged according to the recovered switching bit, which suppresses the noise and simplifies the subsequent process. A field programmable gate array (FPGA) based real-time platform is built for experimental demonstration. The experimental results show that the proposed MR-PS-QPSK modulation format with correlated CMA can provide 3.2 dB optical signal-to-noise ratio (OSNR) improvement over dual-polarization QPSK (DP-QPSK) at back-to-back case and 3.8 dB OSNR improvement after fiber transmission at the same symbol rate, which corresponds to be about 2 dB OSNR improvement at the same bit rate. The resource consumption analysis in FPGA digital signal processing blocks and logic utilizations shows that the MR-PS-QPSK with correlated CMA only requires a small additional computational effort.

  3. DISTANCE AND KINEMATICS OF THE RED HYPERGIANT VY CMa: VERY LONG BASELINE ARRAY AND VERY LARGE ARRAY ASTROMETRY

    SciTech Connect

    Zhang, B.; Reid, M. J.; Menten, K. M.; Zheng, X. W.

    2012-01-01

    We report astrometric results of phase-referencing very long baseline interferometry observations of 43 GHz SiO maser emission toward the red hypergiant VY Canis Majoris (VY CMa) using the Very Long Baseline Array (VLBA). We measured a trigonometric parallax of 0.83 {+-} 0.08 mas, corresponding to a distance of 1.20{sup +0.13}{sub -0.10} kpc. Compared to previous studies, the spatial distribution of SiO masers has changed dramatically, while its total extent remains similar. The internal motions of the maser spots are up to 1.4 mas yr{sup -1}, corresponding to 8 km s{sup -1}, and show a tendency for expansion. After modeling the expansion of maser spots, we derived an absolute proper motion for the central star of {mu}{sub x} = -2.8 {+-} 0.2 and {mu}{sub y} = 2.6 {+-} 0.2 mas yr{sup -1} eastward and northward, respectively. Based on the maser distribution from the VLBA observations, and the relative position between the radio photosphere and the SiO maser emission at 43 GHz from the complementary Very Large Array observations, we estimate the absolute position of VY CMa at mean epoch 2006.53 to be {alpha}{sub J2000} = 07{sup h}22{sup m}58.{sup s}3259 {+-} 0.{sup s}0007, {delta}{sub J2000} = -25 Degree-Sign 46'03.''063 {+-} 0.''010. The position and proper motion of VY CMa from the VLBA observations differ significantly with values measured by the Hipparcos satellite. These discrepancies are most likely associated with inhomogeneities and dust scattering the optical light in the circumstellar envelope. The absolute proper motion measured with VLBA suggests that VY CMa may be drifting out of the giant molecular cloud to the east of it.

  4. CoCMA: Energy-Efficient Coverage Control in Cluster-Based Wireless Sensor Networks Using a Memetic Algorithm

    PubMed Central

    Jiang, Joe-Air; Chen, Chia-Pang; Chuang, Cheng-Long; Lin, Tzu-Shiang; Tseng, Chwan-Lu; Yang, En-Cheng; Wang, Yung-Chung

    2009-01-01

    Deployment of wireless sensor networks (WSNs) has drawn much attention in recent years. Given the limited energy for sensor nodes, it is critical to implement WSNs with energy efficiency designs. Sensing coverage in networks, on the other hand, may degrade gradually over time after WSNs are activated. For mission-critical applications, therefore, energy-efficient coverage control should be taken into consideration to support the quality of service (QoS) of WSNs. Usually, coverage-controlling strategies present some challenging problems: (1) resolving the conflicts while determining which nodes should be turned off to conserve energy; (2) designing an optimal wake-up scheme that avoids awakening more nodes than necessary. In this paper, we implement an energy-efficient coverage control in cluster-based WSNs using a Memetic Algorithm (MA)-based approach, entitled CoCMA, to resolve the challenging problems. The CoCMA contains two optimization strategies: a MA-based schedule for sensor nodes and a wake-up scheme, which are responsible to prolong the network lifetime while maintaining coverage preservation. The MA-based schedule is applied to a given WSN to avoid unnecessary energy consumption caused by the redundant nodes. During the network operation, the wake-up scheme awakens sleeping sensor nodes to recover coverage hole caused by dead nodes. The performance evaluation of the proposed CoCMA was conducted on a cluster-based WSN (CWSN) under either a random or a uniform deployment of sensor nodes. Simulation results show that the performance yielded by the combination of MA and wake-up scheme is better than that in some existing approaches. Furthermore, CoCMA is able to activate fewer sensor nodes to monitor the required sensing area. PMID:22408561

  5. Federal budget thrusts CMA into media spotlight during 1995 Leadership Conference

    PubMed Central

    Sullivan, Patrick

    1995-01-01

    The CMA's March Leadership Conference provided the forum for a debating match about the future of Canada's health care system. Two politicians, Premier Frank McKenna of New Brunswick and Diane Marleau, the federal health minister, challenged the CMA contention that the 1995 federal budget may “sound the death knell” for Canada's medicare system. Imagesp1288-ap1289-a

  6. The CMA Code of Ethics: more room for reflection.

    PubMed

    Kenny, N P

    1996-10-15

    Codes of ethics stand as a promise to society about the integrity of a profession in return for the power and authority given to that profession by society. The revised CMA Code of Ethics (see pages 1176A to 1176B) is timely and significant and should be applauded and supported by all physicians. It speaks clearly to competence, high standards of practice and communication, and the importance of informed patient choice. Nonetheless, the code provides no systematic justification for the principles it asserts. Although these principles are helpful tools, they are insufficient to resolve major ethical dilemmas. The code provides no means of ordering ethical priorities and fails to address issues such as peer review and conflict of interest. It is deafeningly silent on both abortion and euthanasia. In view of these limitations, the code must be seen as an important but unfinished reflection on the essence of being a good physician.

  7. Testing of CMA-2000 Microwave Landing System (MLS) airborne receiver

    NASA Astrophysics Data System (ADS)

    Labreche, L.; Murfin, A. J.

    1989-09-01

    Microwave landing system (MLS) is a precision approach and landing guidance system which provides position information and various air to ground data. Position information is provided on a wide coverage sector and is determined by an azimuth angle measurement, an elevation angle measurement, and a range measurement. MLS performance standards and testing of the MLS airborne receiver is mainly governed by Technical Standard Order TSO-C104 issued by the Federal Aviation Administration. This TSO defines detailed test procedures for use in determining the required performance under standard and stressed conditions. It also imposes disciplines on software development and testing procedures. Testing performed on the CMA-2000 MLS receiver and methods used in its validation are described. A computer automated test system has been developed to test for compliance with RTCA/DO-177 Minimum Operation Performance Standards. Extensive software verification and traceability tests designed to ensure compliance with RTCA/DO-178 are outlined.

  8. Symptoms suggestive of cow's milk allergy in infancy and pediatric inflammatory bowel disease.

    PubMed

    Virta, Lauri J; Kautiainen, Hannu; Kolho, Kaija-Leena

    2016-06-01

    Risk factors of pediatric inflammatory bowel disease (PIBD) are incompletely understood. Recently, we reported that among patients with PIBD, a previous diagnosis of cow's milk allergy (CMA) and asthma occurred more frequently than among age- and sex-matched peers. We tested at a national level the hypothesis that CMA is associated with the risk of contracting PIBD. A nationwide birth cohort (n = 225,041), including all Finnish children born between 1999 and 2002, was followed up until July 1, 2014. We identified all children with a diagnosis of CMA, asthma, and PIBD from a national register; the data were based on certificates, including diagnostic criteria. The 95% confidence intervals (CI) for the incidence rates per 100,000 person-years were calculated assuming a Poisson distribution. We identified 7,910 infants with CMA yielding a cumulative incidence of 3.5% by 2 years of age. The cumulative incidence of PIBD was 0.14% (n = 316) and that of asthma 6.6% (14,807). Children with CMA were more likely to develop PIBD than non-CMA children, incidence ratio 2.6 (95% CI 1.7-3.8). Children with a diagnosis of CMA contracted PIBD at a younger age than the respective non-CMA group (9 vs. 11 years, p < 0.05). The risk was more evident for ulcerative colitis than for Crohn's disease. The association between CMA and asthma was stronger than that between CMA and PIBD. CMA in infancy is associated with subsequent development of asthma and PIBD. This suggests that in a subgroup of patients, CMA may share underlying background with PIBD, warranting thorough follow-up. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. CmaE: a transferase shuttling aminoacyl groups between carrier protein domains in the coronamic acid biosynthetic pathway.

    PubMed

    Strieter, Eric R; Vaillancourt, Frédéric H; Walsh, Christopher T

    2007-06-26

    During the biosynthesis of the cyclopropyl amino acid coronamic acid from l-allo-Ile by the phytotoxic Pseudomonas syringae, the aminoacyl group covalently attached to the pantetheinyl arm of CmaA is shuttled to the HS-pantetheinyl arm of the protein CmaD by the aminoacyltransferase CmaE. CmaE will only recognize deacylated CmaA for initial complexation. The aminoacyl group becomes covalently attached to the active site Cys of CmaE and can then be transferred out to the holo pantetheinylated form of CmaD. Both l-Val/l-[14C]Val exchange studies and MALDI-TOF support a reversible shuttling process. Aminoacylated-S-CmaE will transfer the l-Val moiety to the HS-pantetheinyl arm of other T domains, including CytC2, BarA, and ArfA C2-A2-T2 but not to free HS-pantetheine. CmaD could be loaded with other amino acids, for example, l-Leu and l-Thr, by the action of heterologous donor T domains containing alternative aminoacyl groups. Additionally, CmaE is able to accept l-Phe as a substrate when presented on CmaD and is able to load this aminoacyl moiety onto heterologous T domains, expanding the potential for CmaE to be used as a tool for generating chemical diversity within an NRPS assembly line.

  10. Historical patterns in presentations at the American Society of Pediatric Otolaryngology (ASPO): using a searchable database of the ASPO Program to show the trends of an otolaryngology subspecialty.

    PubMed

    Sitton, Matthew S; MacKinney, Erin; Garcia-Rodriguez, Laura; Kerschner, Joseph E

    2013-09-01

    To describe the development of American Society of Pediatric Otolaryngology (ASPO). To utilize a searchable database of meeting programs to demonstrate content presented at a major meeting since its inception. To utilize a searchable database of meeting programs to show trends of pediatric otolaryngology. Programs of ASPO meetings from 1986 to 2011 were reviewed using a searchable database. Number of podium presentations and length of podium presentations per meeting were collected. Podium presentations were placed into broad categories from reviewing presentation title. Broad categories included tonsils and adenoid, otology, airway, head and neck masses, and sinus disease. First author, location of first author, length of presentation, and publication status were collected for each podium presentation. An average of 49 (range 31-76) podium presentations were presented at each meeting. The average length of podium presentation was 8.3 min (range of 5-20 min). Tonsil and adenoids made up 9% (range 0-22%) of the program, otology made up 26% (range 15-44%) of the program, airway made up 34% (18-48%) the program, head and neck masses made up 8.7% (0-18.5%) of the program, sinus disease made up 6.2% (0-23%) of the program. Fifty-four percent (54%) of podium presentations were published. This is a unique example of utilizing searchable databases constructed from published programs of a major otolaryngology meeting to assess topics presented and areas of emphasis. The areas of emphasis at ASPO over its 26 years are airway, otology, tonsil and adenoid issues, head and neck masses, and sinus disease in the pediatric population. Percent of time given to each topic has changed from ASPO's beginning to today. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Cow's milk allergy, asthma, and pediatric IBD.

    PubMed

    Virta, Lauri J; Ashorn, Merja; Kolho, Kaija-Leena

    2013-06-01

    We identified a total of 595 Finnish children born in 1994-2008 and diagnosed as having inflammatory bowel disease (IBD) by October 2010 from the National Reimbursement Register (based on certificates including the diagnostic criteria) to determine whether the presence of cow's milk allergy (CMA) or asthma is associated with the risk of contracting IBD (altogether 2380 matched controls). A diagnosis of CMA in infancy was associated with Crohn disease (odds ratio [OR] 1.92, confidence interval [CI] 1.09-3.36, P < 0.05) and ulcerative colitis (OR 1.71, CI 1.04-2.83, P < 0.05), but childhood asthma only with Crohn disease (OR 2.33, CI 1.41-3.86, P = 0.001). Thus, CMA in infants is a risk factor for contracting pediatric IBD and accordingly, asthma for Crohn disease.

  12. CMA-HT: a crowd motion analysis framework based on heat-transfer analog model

    NASA Astrophysics Data System (ADS)

    Liang, Yu; Melvin, William; Sritharan, Subramania I.; Fernandes, Shane; Barker, Darrell

    2012-06-01

    Crowd motion analysis covers the detection, tracking, recognition, and behavior interpretation of target group from persistent surveillance video data. This project is dedicated to investigating a crowd motion analysis system based on a heat-transfer-analog model (denoted as CMA-HT for simplicity), and a generic modeling and simulation framework describing crowd motion behavior. CMA-HT is formulated by coupling the statistical analysis of crowd's historical behavior at a given location, geographic information system, and crowd motion dynamics. The mathematical derivation of the CMA-HT model and the innovative methods involved in the framework's implementation will be discussed in detail. Using the sample video data collected by Central Florida University as benchmark, CMA-HT is employed to measure and identify anomalous personnel or group responses in the video.

  13. Chromosomal Microarray Analysis (CMA) a Clinical Diagnostic Tool in the Prenatal and Postnatal Settings.

    PubMed

    Batzir, Nurit Assia; Shohat, Mordechai; Maya, Idit

    2015-09-01

    Chromosomal microarray analysis (CMA) is a technology used for the detection of clinically-significant microdeietions or duplications, with a high sensitivity for submicroscopic aberrations. It is able to detect changes as small as 5-10Kb in size - a resolution up to 1000 times higher than that of conventional karyotyping. CMA is used for uncovering copy number variants (CNVs) thought to play an important role in the pathogenesis of a variety of disorders, primarily neurodevelopmental disorders and congenital anomalies. CMA may be applied in the prenatal or postnatal setting, with unique benefits and limitations in each setting. The growing use of CMA makes it essential for practicing physicians to understand the principles of this technology and be aware of its powers and limitations.

  14. B fields in OB stars (BOB): on the detection of weak magnetic fields in the two early B-type stars β CMa and ɛ CMa. Possible lack of a "magnetic desert" in massive stars

    NASA Astrophysics Data System (ADS)

    Fossati, L.; Castro, N.; Morel, T.; Langer, N.; Briquet, M.; Carroll, T. A.; Hubrig, S.; Nieva, M. F.; Oskinova, L. M.; Przybilla, N.; Schneider, F. R. N.; Schöller, M.; Simón-Díaz, S.; Ilyin, I.; de Koter, A.; Reisenegger, A.; Sana, H.

    2015-02-01

    Only a small fraction of massive stars seem to host a measurable structured magnetic field, whose origin is still unknown and whose implications for stellar evolution still need to be assessed. Within the context of the "B fields in OB stars (BOB)" collaboration, we used the HARPSpol spectropolarimeter to observe the early B-type stars β CMa (HD 44743; B1 II/III) and ɛ CMa (HD 52089; B1.5II) in December 2013 and April 2014. For both stars, we consistently detected the signature of a weak (<30 G in absolute value) longitudinal magnetic field, approximately constant with time. We determined the physical parameters of both stars and characterise their X-ray spectrum. For the β Cep star β CMa, our mode identification analysis led to determining a rotation period of 13.6 ± 1.2 days and of an inclination angle of the rotation axis of 57.6 ± 1.7°, with respect to the line of sight. On the basis of these measurements and assuming a dipolar field geometry, we derived a best fitting obliquity of about 22° and a dipolar magnetic field strength (Bd) of about 100 G (60 CMa we could only determine a lower limit on the dipolar magnetic field strength of 13 G. For this star, we determine that the rotation period ranges between 1.3 and 24 days. Our results imply that both stars are expected to have a dynamical magnetosphere, so the magnetic field is not able to support a circumstellar disk. We also conclude that both stars are most likely core hydrogen burning and that they have spent more than 2/3 of their main sequence lifetime. Ahistogram of the distribution of the dipolar magnetic field strength for the magnetic massive stars known to date does not show the magnetic field "desert" observed instead for intermediate-mass stars. The biases involved in the detection of (weak) magnetic

  15. Techniques for managing behaviour in pediatric dentistry: comparative study of live modelling and tell-show-do based on children's heart rates during treatment.

    PubMed

    Farhat-McHayleh, Nada; Harfouche, Alice; Souaid, Philippe

    2009-05-01

    Tell-show-do is the most popular technique for managing children"s behaviour in dentists" offices. Live modelling is used less frequently, despite the satisfactory results obtained in studies conducted during the 1980s. The purpose of this study was to compare the effects of these 2 techniques on children"s heart rates during dental treatments, heart rate being the simplest biological parameter to measure and an increase in heart rate being the most common physiologic indicator of anxiety and fear. For this randomized, controlled, parallel-group single-centre clinical trial, children 5 to 9 years of age presenting for the first time to the Saint Joseph University dental care centre in Beirut, Lebanon, were divided into 3 groups: those in groups A and B were prepared for dental treatment by means of live modelling, the mother serving as the model for children in group A and the father as the model for children in group B. The children in group C were prepared by a pediatric dentist using the tell-show-do method. Each child"s heart rate was monitored during treatment, which consisted of an oral examination and cleaning. A total of 155 children met the study criteria and participated in the study. Children who received live modelling with the mother as model had lower heart rates than those who received live modelling with the father as model and those who were prepared by the tell-show-do method (p < 0.01). The model used for live modelling (father or mother) and the child"s age were determining factors in the results obtained. Live modelling is a technique worth practising in pediatric dentistry.

  16. Cow's milk allergy (CMA) in children: identification of allergologic tests predictive of food allergy.

    PubMed

    Bellini, F; Ricci, G; Remondini, D; Pession, A

    2014-05-01

    Oral food challenge (OFC) is still considered the gold standard for diagnosis of food allergy (FA). Skin prick test (SPT) and specific IgE (sIgE) tests are very useful but limited in their predictive accuracy. End point test (EPT) has been recently considered to determine the starting dose to induce oral desensitization. Allergometric tests combined may discriminate children at higher risk of reactions during OFC. We considered 94 children referred to our Allergy and Immunology Pediatric Department between January 2009 and December 2011 with CMA. Cutaneous allergometric skin tests (SPT and EPT) were periodically performed on all 94 children with CMA; sIgE levels against cow's milk proteins (CMP) α-lactalbumin, β-lactoglobulin and casein were periodically evaluated through blood samples every 6-12 months. During the period of the study, 26/94 (27.6%) children underwent more than once OFC. We collected 135 OFC compared with clinical presentation: 49/135 (36.2%) OFC were performed shortly after the onset of symptoms directly related to spontaneous intake of milk, to confirm suspicion of FA; 86/135 (63.7%) OFC were performed to evaluate the acquisition of tolerance. Of these, 52/86 (60.4%) OFC resulted positive, 34/86 (39.5%) were negative. The 3D EPT has the best ratio sensitivity (SE) / positive predictive value (PPV), SE 83%, specificity (SP) 58.3%, PPV 89.3%, negative predictive value (NPV) 45.1%. EPT 6D and 7D have the best PPV (100%) with a low NPV (respectively 22.2% and 21.2%). We obtained that a mean fresh milk wheal diameter ≥ 12 mm was predictive of 97% OFC, but only 32/101 (31.6%) allergic children presented this value. The tests with a wheal diameter ≤ 5 were performed on younger children, all of which were less than 9 months old; only 5 other tests performed on less than 9 months olds resulted in the others subgroups (1 in ≥ 12 mm wheal and 4 in the group between 6-11 mm). We also found that 95% of children with 4D EPT wheal diameter < 6 mm

  17. The 2008 Outburst in the Young Stellar System Z CMa: The First Detection of Twin Jets

    NASA Astrophysics Data System (ADS)

    Whelan, E. T.; Dougados, C.; Perrin, M. D.; Bonnefoy, M.; Bains, I.; Redman, M. P.; Ray, T. P.; Bouy, H.; Benisty, M.; Bouvier, J.; Chauvin, G.; Garcia, P. J. V.; Grankvin, K.; Malbet, F.

    2010-09-01

    The Z CMa binary is understood to undergo both FU Orionis (FUOR) and EX Orionis (EXOR) type outbursts. While the SE component has been spectroscopically classified as an FUOR, the NW component, a Herbig Be star, is the source of the EXOR outbursts. The system has been identified as the source of a large outflow; however, previous studies have failed to identify the driver. Here, we present adaptive optics assisted [Fe II] spectro-images which reveal for the first time the presence of two small-scale jets. Observations made using OSIRIS at the Keck Observatory show the Herbig Be star to be the source of the parsec-scale outflow, which within 2'' of the source shows signs of wiggling and the FUOR to be driving a ~0farcs4 jet. The wiggling of the Herbig Be star's jet is evidence for an additional companion which could in fact be generating the EXOR outbursts, the last of which began in 2008. Indeed, the dynamical scale of the wiggling corresponds to a timescale of 4-8 years which is in agreement with the timescale of these outbursts. The spectro-images also show a bow-shock-shaped feature and possible associated knots. The origin of this structure is as of yet unclear. Finally, interesting low velocity structure is also observed. One possibility is that it originates in a wide-angle outflow launched from a circumbinary disk.

  18. To Find a Safe Dose and Show Early Clinical Activity of Weekly Nab-paclitaxel in Pediatric Patients With Recurrent/ Refractory Solid Tumors

    ClinicalTrials.gov

    2017-03-02

    Neuroblastoma; Rhabdomyosarcoma; Ewing's Sarcoma; Ewing's Tumor; Sarcoma, Ewing's; Sarcomas, Epitheliod; Sarcoma, Soft Tissue; Sarcoma, Spindle Cell; Melanoma; Malignant Melanoma; Clinical Oncology; Oncology, Medical; Pediatrics, Osteosarcoma; Osteogenic Sarcoma; Osteosarcoma Tumor; Sarcoma, Osteogenic; Tumors; Cancer; Neoplasia; Neoplasm; Histiocytoma; Fibrosarcoma; Dermatofibrosarcoma

  19. A X-ray view of the young star population in CMa R1

    NASA Astrophysics Data System (ADS)

    Santos-Silva, T.; Gregorio-Hetem, J.; Montmerle, T.

    2014-10-01

    In previous works we studied the star formation scenario in the molecular cloud Canis Major R1 (CMa R1), revealing the existence of young stellar groups near the Be stars Z CMa and GU CMa. Using data from the ROSAT X-ray satellite, Gregorio-Hetem et al. (2009) - GH2009 - discovered in this region young stellar objects (YSOs) mainly grouped in two clusters of different ages. In order to investigate the nature of these objects and to test a possible scenario of sequential star formation in this region, four fields (each 30' diameter, with some overlap - Figure 1) have been observed with the XMM-Newton satellite that has a sensitivity about 10 times better than ROSAT.

  20. Toward Understanding the B[e] Phenomenon. II. New Galactic FS CMa Stars

    NASA Astrophysics Data System (ADS)

    Miroshnichenko, A. S.; Manset, N.; Kusakin, A. V.; Chentsov, E. L.; Klochkova, V. G.; Zharikov, S. V.; Gray, R. O.; Grankin, K. N.; Gandet, T. L.; Bjorkman, K. S.; Rudy, R. J.; Lynch, D. K.; Venturini, C. C.; Mazuk, S.; Puetter, R. C.; Perry, R. B.; Levato, H.; Grosso, M.; Bernabei, S.; Polcaro, V. F.; Viotti, R. F.; Norci, L.; Kuratov, K. S.

    2007-12-01

    FS CMa stars form a group of objects with the B[e] phenomenon that were previously known as unclassified B[e] stars or B[e] stars with warm dust (B[e]WD) until recently. They exhibit strong emission-line spectra and strong IR excesses, most likely due to recently formed circumstellar dust. These properties have been suggested to be due to ongoing or recent rapid mass exchange in binary systems with hot primaries and various types of secondaries. The first paper of this series reported an analysis of the available information about previously known Galactic objects with the B[e] phenomenon, the initial selection of the FS CMa group objects, and a qualitative explanation of their properties. This paper reports the results of our new search for more FS CMa objects in the IRAS Point Source Catalog. We present new photometric criteria for identifying FS CMa stars as well as the first results of our observations of nine new FS CMa group members. With this addition, the FS CMa group has now 40 members, becoming the largest among the dust-forming hot star groups. We also present nine objects with no evidence for the B[e] phenomenon, but with newly discovered spectral line emission and/or strong IR excesses. Partially based on data obtained at the 6 m BTA Telescope of the Russian Academy of Sciences, 3.6 m Canada-France-Hawaii Telescope, 3 m Shane Telescope of the Lick Observatory, 2.7 m Harlan J. Smith and 2.1 m Otto Struve Telescopes of the McDonald Observatory, 2.1 m telescope of the San Pedro Martir Observatory, 1.5 m telescope of the Loiano Observatory, and 0.8 m telescope of the Dark Sky Observatory.

  1. Analysis of common cytogenetic abnormalities in New Zealand pediatric ALL shows ethnically diverse carriage of ETV6-RUNX1, without a corresponding difference in survival.

    PubMed

    Pettit, Tristan; Cole, Nyree; Leung, Wingchi; Ballantine, Kirsten; Macfarlane, Scott

    2017-06-09

    The frequency of common cytogenetic abnormalities in pediatric acute lymphoblastic leukemia (ALL) is known to vary by geographic location and ethnic origin. This study aimed to determine the frequency of hypodiploidy, ETV6-RUNX1, BCR-ABL1, and MLL rearrangement within New Zealand's pediatric ALL population and to assess whether the frequency of these ALL prognostic markers varies according to ethnicity. The New Zealand Children's Cancer Registry provided information for all registered pediatric ALL patients that were diagnosed between 2000 and 2009, with medical records available for 246 patients. Each patient's medical record was reviewed to determine the frequency of hypodiploidy, ETV6-RUNX1, BCR-ABL1, MLL rearrangement, and cell lineage. Chi-square tests for independence were undertaken to compare the frequencies of cytogenetic abnormalities according to prioritized ethnicity. The frequency of cytogenetic ALL abnormalities in the New Zealand pediatric population were consistent with international reference values. A low frequency of ETV6-RUNX1 was evident for Maori pediatric ALL patients (5.4%, P = 0.018), when compared to Pacific peoples (21.1%) and non-Maori/non-Pacific peoples (27.4%). This has not impacted on outcome, however, with equivalent 5-year overall survival being observed in Maori (89.4%) compared to Pacific peoples (92.0%) and non-Maori/non-Pacific peoples (90.2%). A lower frequency of the favorable prognostic marker ETV6-RUNX1 was observed in Maori pediatric ALL patients. This did not translate into poorer survival. Future research into biological and nonbiological prognostic factors in this patient population may assist in explaining this finding. © 2017 Wiley Periodicals, Inc.

  2. [Chromosome CPD(PI/DAPI)- and CMA/DAPI-banding patterns in Allium cepa L].

    PubMed

    Kim, E S; Punina, E O; Rodionov, A V

    2002-04-01

    Chromosome banding patterns of Allium cepa L. were obtained by using fluorochrome combinations chromomycin A3 (CMA) + 4',6-diamidino-2-phenylindole (DAPI), DAPI + actinomycin D (AMD) and propidium iodide (PI) + DAPI. In A. cepa, telomeric heterochromatin displayed dull fluorescence after staining with DAPI and DAPI/AMD. After staining with the GC-specific CMA and AT-specific DAPI, the CMA-positive fluorescence of the NOR region and the telomeric bands of C-heterochromatin was observed. In combination with DAPI, PI, a dye with low AT/GC specificity, produced almost uniform fluorescence of chromosomal arms and heterochromatin, whereas the NOR-adjoining regions displayed bright fluorescence. Denaturation of chromosomal DNA (95 degrees C for 1-3 min) followed by renaturation in the 2 x SSC buffer (37 degrees C, 12 h) altered the chromosome fluorescence patterns: specific PI-positive bands appeared and the contrast of CMA-banding increased. Bright fluorescence of the NOR and adjoining regions was also observed in the case. Three-minute denaturation led also to a bright PI-positive fluorescence of telomeric heterochromatin. The denaturation of chromosomal DNA before staining results in changes of the DAPI fluorescence pattern and in the appearance of DAPI fluorescence in GR-rich NOP regions. The mechanisms underlying the effects of denaturation/renaturation procedures on chromosome banding patterns obtained with different fluorochromes are discussed.

  3. Results from CMA's huge 1998 physician survey point to a dispirited profession

    PubMed Central

    Sullivan, P; Buske, L

    1998-01-01

    Results from the CMA's 1998 Physician Resource Questionnaire are in, and they point to a serious decline in physician morale. The PRQ, the country's most important poll of physician attitudes, provides an annual "state-of-the-nation" message for the medical profession. PMID:9757182

  4. LM-CMA: An Alternative to L-BFGS for Large-Scale Black Box Optimization.

    PubMed

    Loshchilov, Ilya

    2017-01-01

    Limited-memory BFGS (L-BFGS; Liu and Nocedal, 1989 ) is often considered to be the method of choice for continuous optimization when first- or second-order information is available. However, the use of L-BFGS can be complicated in a black box scenario where gradient information is not available and therefore should be numerically estimated. The accuracy of this estimation, obtained by finite difference methods, is often problem-dependent and may lead to premature convergence of the algorithm. This article demonstrates an alternative to L-BFGS, the limited memory covariance matrix adaptation evolution strategy (LM-CMA) proposed by Loshchilov ( 2014 ). LM-CMA is a stochastic derivative-free algorithm for numerical optimization of nonlinear, nonconvex optimization problems. Inspired by L-BFGS, LM-CMA samples candidate solutions according to a covariance matrix reproduced from m direction vectors selected during the optimization process. The decomposition of the covariance matrix into Cholesky factors allows reducing the memory complexity to [Formula: see text], where n is the number of decision variables. The time complexity of sampling one candidate solution is also [Formula: see text] but scales as only about 25 scalar-vector multiplications in practice. The algorithm has an important property of invariance with respect to strictly increasing transformations of the objective function; such transformations do not compromise its ability to approach the optimum. LM-CMA outperforms the original CMA-ES and its large-scale versions on nonseparable ill-conditioned problems with a factor increasing with problem dimension. Invariance properties of the algorithm do not prevent it from demonstrating a comparable performance to L-BFGS on nontrivial large-scale smooth and nonsmooth optimization problems.

  5. Conformal Microwave Array (CMA) Applicators for Hyperthermia of Diffuse Chestwall Recurrence

    PubMed Central

    Stauffer, Paul R.; Maccarini, Paolo; Arunachalam, Kavitha; Craciunescu, Oana; Diederich, Chris; Juang, Titania; Rossetto, Francesca; Schlorff, Jaime; Milligan, Andrew; Hsu, Joe; Sneed, Penny; Vujaskovic, Zeljko

    2010-01-01

    Purpose This article summarizes the evolution of microwave array applicators for heating large area chestwall disease as an adjuvant to external beam radiation, systemic chemotherapy, and potentially simultaneous brachytherapy. Methods Current devices used for thermotherapy of chestwall recurrence are reviewed. The largest conformal array applicator to date is evaluated in four studies: i) ability to conform to the torso is demonstrated with a CT scan of a torso phantom and MR scan of the conformal waterbolus component on a mastectomy patient; ii) Specific Absorption Rate (SAR) and temperature distributions are calculated with electromagnetic and thermal simulation software for a mastectomy patient; iii). SAR patterns are measured with a scanning SAR probe in liquid muscle phantom for a buried coplanar waveguide CMA; and iv) heating patterns and patient tolerance of CMA applicators are characterized in a clinical pilot study with 13 patients. Results CT and MR scans demonstrate excellent conformity of CMA applicators to contoured anatomy. Simulations demonstrate effective control of heating over contoured anatomy. Measurements confirm effective coverage of large treatment areas with no gaps. In 42 hyperthermia treatments, CMA applicators provided well-tolerated effective heating of up to 500cm2 regions, achieving target temperatures of Tmin=41.4±0.7°C, T90=42.1±0.6°C, Tave=42.8±0.6°C, and Tmax=44.3±0.8°C as measured in an average of 90 points per treatment. Summary The CMA applicator is an effective thermal therapy device for heating large-area superficial disease such as diffuse chestwall recurrence. It is able to cover over three times the treatment area of conventional hyperthermia devices while conforming to typical body contours. PMID:20849262

  6. Conformal microwave array (CMA) applicators for hyperthermia of diffuse chest wall recurrence.

    PubMed

    Stauffer, Paul R; Maccarini, Paolo; Arunachalam, Kavitha; Craciunescu, Oana; Diederich, Chris; Juang, Titania; Rossetto, Francesca; Schlorff, Jaime; Milligan, Andrew; Hsu, Joe; Sneed, Penny; Vujaskovic, Zeljko

    2010-01-01

    This article summarises the evolution of microwave array applicators for heating large area chest wall disease as an adjuvant to external beam radiation, systemic chemotherapy, and potentially simultaneous brachytherapy. Current devices used for thermotherapy of chest wall recurrence are reviewed. The largest conformal array applicator to date is evaluated in four studies: (1) ability to conform to the torso is demonstrated with a CT scan of a torso phantom and MR scan of the conformal water bolus component on a mastectomy patient; (2) specific absorption rate (SAR) and temperature distributions are calculated with electromagnetic and thermal simulation software for a mastectomy patient; (3) SAR patterns are measured with a scanning SAR probe in liquid muscle phantom for a buried coplanar waveguide CMA; and (4) heating patterns and patient tolerance of CMA applicators are characterised in a clinical pilot study with 13 patients. CT and MR scans demonstrate excellent conformity of CMA applicators to contoured anatomy. Simulations demonstrate effective control of heating over contoured anatomy. Measurements confirm effective coverage of large treatment areas with no gaps. In 42 hyperthermia treatments, CMA applicators provided well-tolerated effective heating of up to 500 cm(2) regions, achieving target temperatures of T(min) = 41.4 ± 0.7°C, T(90) = 42.1 ± 0.6°C, T(ave) = 42.8 ± 0.6°C, and T(max) = 44.3 ± 0.8°C as measured in an average of 90 points per treatment. The CMA applicator is an effective thermal therapy device for heating large-area superficial disease such as diffuse chest wall recurrence. It is able to cover over three times the treatment area of conventional hyperthermia devices while conforming to typical body contours.

  7. Population pharmacokinetic analysis for 10-monohydroxy derivative of oxcarbazepine in pediatric epileptic patients shows no difference between Japanese and other ethnicities.

    PubMed

    Sugiyama, Ikuo; Bouillon, Thomas; Yamaguchi, Masayuki; Suzuki, Hikoe; Hirota, Takashi; Fink, Martin

    2015-04-01

    Oxcarbazepine is an anti-epileptic drug, which is almost completely metabolized by cytosolic enzymes in the liver to the active 10-monohyroxy metabolite (MHD) following oral administration. The pharmacokinetic (PK) profiles of MHD were evaluated in pediatric epileptic patients and a possible ethnic difference in PK of MHD between Japanese and non-Japanese pediatric patients was assessed. A non-linear mixed effect modeling approach was used to determine the PK of MHD. A one-compartment population model with first-order absorption appropriately described the PK of MHD. No clinically relevant differences were found for using body surface area or weight to explain between-patient variability, therefore the final model included the effects of body weight on apparent clearance (CL/F) and apparent volume of distribution (V/F) of MHD, and in addition, the effect of 3 concomitant anti-epileptic drugs (carbamazepine, phenobarbital and phenytoin) on CL/F of MHD. Inclusion of ethnicity as a covariate in the final model, concluded no ethnic difference with respect to CL/F of MHD between Japanese and non-Japanese patients. Hence, oxcarbazepine can be generally applied using the same dosage and administration for the treatment of partial onset seizures in pediatric patients, regardless of ethnicity.

  8. Molecular Clouds Toward a New OB Association in Pup-CMa

    NASA Astrophysics Data System (ADS)

    May, J.; Gyulbudaghian, A. L.; Alvarez, H.

    2005-10-01

    We have mapped 16 molecular clouds toward a new OB association in the Pup-CMa region to derive their physical properties. The observations were carried out in the 12CO (J = 1 0) line with the Southern millimetre-wave Telescope at Cerro Tololo, Chile. Distances have been determined kinematically using the rotation curve of Brand with R⊙ = 8.5 kpc and V⊙ = 220 km/s. Masses have been derived adopting a CO luminosity to H2 conversion factor X = 3.8 . 1020 molecules cm-2 (K km/s)-1. The observed mean radial velocity of the clouds is comparable with the mean radial velocity of stars composing an OB association in Pup-CMa; it is in favor of the close connection of clouds with these stars.

  9. Action on RRSPs remains at top of CMA's priority list in 1995, board decides

    PubMed Central

    Sullivan, Patrick

    1995-01-01

    Potential changes to registered retirement savings plan (RRSP) regulations “continue to generate a huge amount of concern” among physicians, the Board of Directors was told at its December meeting. That anxiety explains why the RRSP issue and related lobbying will remain at the top of the CMA's priority list in 1995. The other major topic of concern during the 3-day meeting was the federal government's proposed gun-control legislation. If doctors are going to have a responsibility to report patients whose ownership of firearms may make them a danger to themselves or others, the CMA wants to ensure that physicians who make such reports are protected under the law. Imagesp254-ap255-a

  10. Professional unity to be a key focus for CMA in 1996

    PubMed Central

    Sullivan, Patrick

    1996-01-01

    The need for professional unity in the face of growing government pressure is to be a key focus of the CMA's 1996 activities, the Board of Directors decided at its December meeting. This will become clear as its future of health care campaign develops, with twin components of patient and physician advocacy. The board also learned that details about a major antismoking project have been finalized and of potential expansion within the Department of Publications.

  11. Past presidents join forces to refurbish gravesite of Sir Charles Tupper, first CMA president.

    PubMed Central

    Robb, N

    1995-01-01

    The CMA's past presidents have donated a plaque and refurbished the headstone and plot at the Halifax gravesite of Sir Charles Tupper, the association's first president. "Sir Charles Tupper was a very significant personality in the conception of a national medical association and the past presidents wanted that fact to be remembered," Dr. Athol Roberts says of the endeavour. Images p632-a p633-a PMID:7641161

  12. Physicians debate Internet-related marital problems on CMA's online service

    PubMed Central

    Sullivan, P

    1997-01-01

    The Internet itself has been the topic recently on the CMA's Internet-based discussion group for physicians, Clinical Q&A. A recent discussion involved physicians from around the country who have dealt with patients with marital problems related to the Internet. They concluded that the Internet may have made problems manifest, but the underlying issue--marital disharmony--already existed. PMID:9176432

  13. FS CMa Type Objects - Products of Intermediate-Mass Non-Conservative Evolution

    NASA Astrophysics Data System (ADS)

    Miroshnichenko, A. S.

    2017-02-01

    The group of FS CMa type objects was formed nearly 10 years ago based on previously unclassified objects with the B[e] phenomenon. The main observational features of the group objects include strong emission-line spectra, typical of hot stars, and infrared excesses due to radiation of mostly hot circumstellar dust. Nearly one third of the group objects exhibit various signs of a cool stellar component that indicates a binary nature. The hot components have been shown to have nearly main sequence luminosities. However, mass loss rates that are much higher than those expected from single hot stars in this region of the Hertzsprung-Russell diagram are required to explain the observed emission-line strengths. Nevertheless, spectroscopic orbits have been determined only in two cases. The evolutionary state of the FS CMa objects is still not well constrained, although several possibilities, such as pre-main-sequence stars or proto-planetary nebulae, have been eliminated. I will review typical properties of the FS CMa objects and focus on a few well-studied examples. Possible evolutionary scenarios leading to the observed features will be discussed. Searching strategies for finding more group objects as well as their predecessor and successor objects will be outlined.

  14. Reducing the time complexity of the derandomized evolution strategy with covariance matrix adaptation (CMA-ES).

    PubMed

    Hansen, Nikolaus; Müller, Sibylle D; Koumoutsakos, Petros

    2003-01-01

    This paper presents a novel evolutionary optimization strategy based on the derandomized evolution strategy with covariance matrix adaptation (CMA-ES). This new approach is intended to reduce the number of generations required for convergence to the optimum. Reducing the number of generations, i.e., the time complexity of the algorithm, is important if a large population size is desired: (1) to reduce the effect of noise; (2) to improve global search properties; and (3) to implement the algorithm on (highly) parallel machines. Our method results in a highly parallel algorithm which scales favorably with large numbers of processors. This is accomplished by efficiently incorporating the available information from a large population, thus significantly reducing the number of generations needed to adapt the covariance matrix. The original version of the CMA-ES was designed to reliably adapt the covariance matrix in small populations but it cannot exploit large populations efficiently. Our modifications scale up the efficiency to population sizes of up to 10n, where n is the problem dimension. This method has been applied to a large number of test problems, demonstrating that in many cases the CMA-ES can be advanced from quadratic to linear time complexity.

  15. Production of low-cost calcium magnesium acetate (CMA) as an environmentally friendly deicer from cheese whey

    SciTech Connect

    Yang, S.T.; Zhu, H.; Li, Y.; Tang, I.C.

    1993-12-31

    About 28 billion lbs of cheese whey are being wasted in the US because of the high biological oxygen demand (BOD) of whey, disposing of surplus whey is a pollution problem. An innovative, wide-scale solution to the whey disposal problem is to use whey as a zero- or low-cost feedstock for the production of an environmentally safe, noncorrosive, road deicer-calcium magnesium acetate (CMA). CMA can be used to replace some of the 10 to 14 million tons road salt used in the North America for deicing. A novel anaerobic fermentation process is developed to produce calcium magnesium acetate (CMA) from whey permeate. A co-culture consisting of homolactic (S. lactis) and homoacetic (C. formicoaceticum) bacteria was used to convert whey lactose to lactate and then to acetate in continuous, immobilized cell bioreactors. The acetate yield from lactose was {approximately}95% (wt/wt), and the final concentration of acetic acid was 4%. The acetic acid present in the fermentation broth can be recovered by solvent-extraction with a tertiary amine and reacted with dolomitic lime (Ca/MgO) to form a concentrated (>25%) CMA solution. About 25 tons CMA can be produced from a plant processing 1 million lbs whey permeate (4.5% lactose) per day. The production costs are estimated at {approximately}$220/ton CMA, which is only about one third of the present market price for CMA deicer. Therefore, about 0.8 million tons/yr CMA deicer can be produced from the currently unused whey. This will partially fulfill market demand for economically and environmentally sound chemicals for roadway deicing. This also will provide a viable solution to the whey disposal problem currently facing many dairies in the North America.

  16. Pediatric primary central nervous system germ cell tumors of different prognosis groups show characteristic miRNome traits and chromosome copy number variations

    PubMed Central

    2010-01-01

    Background Intracranial pediatric germ cell tumors (GCTs) are rare and heterogeneous neoplasms and vary in histological differentiation, prognosis and clinical behavior. Germinoma and mature teratoma are GCTs that have a good prognosis, while other types of GCTs, termed nongerminomatous malignant germ cell tumors (NGMGCTs), are tumors with an intermediate or poor prognosis. The second group of tumors requires more extensive drug and irradiation treatment regimens. The mechanisms underlying the differences in incidence and prognosis of the various GCT subgroups are unclear. Results We identified a distinct mRNA profile correlating with GCT histological differentiation and prognosis, and also present in this study the first miRNA profile of pediatric primary intracranial GCTs. Most of the differentially expressed miRNAs were downregulated in germinomas, but miR-142-5p and miR-146a were upregulated. Genes responsible for self-renewal (such as POU5F1 (OCT4), NANOG and KLF4) and the immune response were abundant in germinomas, while genes associated with neuron differentiation, Wnt/β-catenin pathway, invasiveness and epithelial-mesenchymal transition (including SNAI2 (SLUG) and TWIST2) were abundant in NGMGCTs. Clear transcriptome segregation based on patient survival was observed, with malignant NGMGCTs being closest to embryonic stem cells. Chromosome copy number variations (CNVs) at cytobands 4q13.3-4q28.3 and 9p11.2-9q13 correlated with GCT malignancy and clinical risk. Six genes (BANK1, CXCL9, CXCL11, DDIT4L, ELOVL6 and HERC5) within 4q13.3-4q28.3 were more abundant in germinomas. Conclusions Our results integrate molecular profiles with clinical observations and provide insights into the underlying mechanisms causing GCT malignancy. The genes, pathways and microRNAs identified have the potential to be novel therapeutic targets. PMID:20178649

  17. Presence of AmpC beta-lactamases, CSA-1, CSA-2, CMA-1, and CMA-2 conferring an unusual resistance phenotype in Cronobacter sakazakii and Cronobacter malonaticus.

    PubMed

    Müller, Andrea; Hächler, Herbert; Stephan, Roger; Lehner, Angelika

    2014-08-01

    Here we describe the presence of two very similar but unusual variants of AmpC cephalosporinase in each Cronobacter sakazakii and C. malonaticus isolates conferring resistance exclusively to first generation cephalosporins. During a survey on the antibiotic resistance patterns of C. sakazakii and C. malonaticus strains isolated from a milk powder production facility, originally two different phenotypes regarding the susceptibility/resistance for the two beta-lactam antibiotics ampicillin (amp) and cephalothin (ceph) were observed: (i) isolates being susceptible for both antibiotics (amp(S)/ceph(S)), and (ii) strains exhibiting susceptibility to ampicillin but resistance to cephalothin (amp(S)/ceph(R)). The latter phenotype (amp(S)/ceph(R)) was observed in the majority of the environmental strains from the facility. Analysis of whole genome sequences of C. sakazakii revealed a gene putatively coding for an AmpC beta-lactamase. Consequently, the ampC genes from both species and both phenotypes were subjected to a cloning approach. Surprisingly, when expressed in Escherichia coli, all transformants exhibited the amp(S)/ceph(R) phenotype regardless of (i) the phenotypic backgrounds or (ii) the AmpC amino acid sequences of the original strains from which the clones were derived. The novel AmpC beta-lactamases were designated CSA-1 and CSA-2 (from C. sakazakii) and CMA-1 and CMA-2 (from C. malonaticus). The observed variations in the minimum inhibitory concentration (MIC) levels for cephalothin (wt compared to transformants) suggest that this feature is a target of a yet unknown regulatory mechanism present in the natural Cronobacter background but absent in the neutral E. coli host.

  18. Synthesis, Biodistribution and In vitro Evaluation of Brain Permeable High Affinity Type 2 Cannabinoid Receptor Agonists [11C]MA2 and [18F]MA3

    PubMed Central

    Ahamed, Muneer; van Veghel, Daisy; Ullmer, Christoph; Van Laere, Koen; Verbruggen, Alfons; Bormans, Guy M.

    2016-01-01

    The type 2 cannabinoid receptor (CB2) is a member of the endocannabinoid system and is known for its important role in (neuro)inflammation. A PET-imaging agent that allows in vivo visualization of CB2 expression may thus allow quantification of neuroinflammation. In this paper, we report the synthesis, radiosynthesis, biodistribution and in vitro evaluation of a carbon-11 ([11C]MA2) and a fluorine-18 ([18F]MA3) labeled analog of a highly potent N-arylamide oxadiazole CB2 agonist (EC50 = 0.015 nM). MA2 and MA3 behaved as potent CB2 agonist (EC50: 3 nM and 0.1 nM, respectively) and their in vitro binding affinity for hCB2 was found to be 87 nM and 0.8 nM, respectively. Also MA3 (substituted with a fluoro ethyl group) was found to have higher binding affinity and EC50 values when compared to the originally reported trifluoromethyl analog 12. [11C]MA2 and [18F]MA3 were successfully synthesized with good radiochemical yield, high radiochemical purity and high specific activity. In mice, both tracers were efficiently cleared from blood and all major organs by the hepatobiliary pathway and importantly these compounds showed high brain uptake. In conclusion, [11C]MA2 and [18F]MA3 are shown to be high potent CB2 agonists with good brain uptake, these favorable characteristics makes them potential PET probes for in vivo imaging of brain CB2 receptors. However, in view of its higher affinity and selectivity, further detailed evaluation of MA3 as a PET tracer for CB2 is warranted. PMID:27713686

  19. Early pediatric atopic dermatitis shows only a cutaneous lymphocyte antigen (CLA)(+) TH2/TH1 cell imbalance, whereas adults acquire CLA(+) TH22/TC22 cell subsets.

    PubMed

    Czarnowicki, Tali; Esaki, Hitokazu; Gonzalez, Juana; Malajian, Dana; Shemer, Avner; Noda, Shinji; Talasila, Sreya; Berry, Adam; Gray, Jayla; Becker, Lauren; Estrada, Yeriel; Xu, Hui; Zheng, Xiuzhong; Suárez-Fariñas, Mayte; Krueger, James G; Paller, Amy S; Guttman-Yassky, Emma

    2015-10-01

    Identifying differences and similarities between cutaneous lymphocyte antigen (CLA)(+) polarized T-cell subsets in children versus adults with atopic dermatitis (AD) is critical for directing new treatments toward children. We sought to compare activation markers and frequencies of skin-homing (CLA(+)) versus systemic (CLA(-)) "polar" CD4 and CD8 T-cell subsets in patients with early pediatric AD, adults with AD, and control subjects. Flow cytometry was used to measure CD69/inducible costimulator/HLA-DR frequency in memory cell subsets, as well as IFN-γ, IL-13, IL-9, IL-17, and IL-22 cytokines, defining TH1/cytotoxic T (TC) 1, TH2/TC2, TH9/TC9, TH17/TC17, and TH22/TC22 populations in CD4 and CD8 cells, respectively. We compared peripheral blood from 19 children less than 5 years old and 42 adults with well-characterized moderate-to-severe AD, as well as age-matched control subjects (17 children and 25 adults). Selective inducible costimulator activation (P < .001) was seen in children. CLA(+) TH2 T cells were markedly expanded in both children and adults with AD compared with those in control subjects, but decreases in CLA(+) TH1 T-cell numbers were greater in children with AD (17% vs 7.4%, P = .007). Unlike in adults, no imbalances were detected in CLA(-) T cells from pediatric patients with AD nor were there altered frequencies of TH22 T cells within the CLA(+) or CLA(-) compartments. Adults with AD had increased frequencies of IL-22-producing CD4 and CD8 T cells within the skin-homing population, compared with controls (9.5% vs 4.5% and 8.6% vs 2.4%, respectively; P < .001), as well as increased HLA-DR activation (P < .01). These data suggest that TH2 activation within skin-homing T cells might drive AD in children and that reduced counterregulation by TH1 T cells might contribute to excess TH2 activation. TH22 "spreading" of AD is not seen in young children and might be influenced by immune development, disease chronicity, or recurrent skin infections

  20. Pseudomonas syringae pv. tomato DC3000 CmaL (PSPTO4723), a DUF1330 Family Member, Is Needed To Produce l-allo-Isoleucine, a Precursor for the Phytotoxin Coronatine

    PubMed Central

    Worley, Jay N.; Russell, Alistair B.; Wexler, Aaron G.; Bronstein, Philip A.; Kvitko, Brian H.; Krasnoff, Stuart B.; Munkvold, Kathy R.; Swingle, Bryan

    2013-01-01

    Pseudomonas syringae pv. tomato DC3000 produces the phytotoxin coronatine, a major determinant of the leaf chlorosis associated with DC3000 pathogenesis. The DC3000 PSPTO4723 (cmaL) gene is located in a genomic region encoding type III effectors; however, it promotes chlorosis in the model plant Nicotiana benthamiana in a manner independent of type III secretion. Coronatine is produced by the ligation of two moieties, coronafacic acid (CFA) and coronamic acid (CMA), which are produced by biosynthetic pathways encoded in separate operons. Cross-feeding experiments, performed in N. benthamiana with cfa, cma, and cmaL mutants, implicate CmaL in CMA production. Furthermore, analysis of bacterial supernatants under coronatine-inducing conditions revealed that mutants lacking either the cma operon or cmaL accumulate CFA rather than coronatine, supporting a role for CmaL in the regulation or biosynthesis of CMA. CmaL does not appear to regulate CMA production, since the expression of proteins with known roles in CMA production is unaltered in cmaL mutants. Rather, CmaL is needed for the first step in CMA synthesis, as evidenced by the fact that wild-type levels of coronatine production are restored to a ΔcmaL mutant when it is supplemented with 50 μg/ml l-allo-isoleucine, the starting unit for CMA production. cmaL is found in all other sequenced P. syringae strains with coronatine biosynthesis genes. This characterization of CmaL identifies a critical missing factor in coronatine production and provides a foundation for further investigation of a member of the widespread DUF1330 protein family. PMID:23144243

  1. The effects of calcium magnesium acetate (CMA) deicing material on the water quality of Bear Creek, Clackamas County, Oregon, 1999

    USGS Publications Warehouse

    Tanner, Dwight Q.; Wood, Tamara M.

    2000-01-01

    This report presents the results of a study by the U.S. Geological Survey, done in cooperation with the Oregon Department of Transportation (ODOT), to evaluate the effects of the highway deicing material, calcium magnesium acetate (CMA), on the water quality of Bear Creek, in the Cascade Range of Oregon. ODOT began using CMA (an alternative deicer that has fewer adverse environmental effects than road salt) in the mid-1990s and began this study with the USGS to ensure that there were no unexpected effects on the water quality of Bear Creek. Streamflow, precipitation, dissolved oxygen, pH, specific conductance, and water temperature were measured continuously through the 1998?99 winter. There was no measurable effect of the application of CMA to Highway 26 on the biochemical oxygen demand (BOD), calcium concentration, or magnesium concentration of Bear Creek and its tributaries. BOD was small in all of the water samples, some of which were collected before CMA application, and some of which were collected after application. Five-day BOD values ranged from 0.1 milligrams per liter to 1.5 milligrams per liter, and 20-day BOD values ranged from 0.2 milligrams per liter to 2.0 milligrams per liter. Dissolved copper concentrations in a small tributary ditch on the north side of Highway 26 exceeded the U.S. Environmental Protection Agency aquatic life criteria on three occasions. These exceedances were probably not caused by the application of CMA because (1) one of the samples was a background sample (no recent CMA application), and (2) dissolved copper was not detected in Bear Creek water samples to which CMA was added during laboratory experiments.

  2. Early auditory processing evoked potentials (N100) show a continuum of blunting from clinical high risk to psychosis in a pediatric sample

    PubMed Central

    Gonzalez-Heydrich, Joseph; Enlow, Michelle Bosquet; D’Angelo, Eugene; Seidman B, Larry J.; Gumlak, Sarah; Kim, April; Woodberry, Kristen A.; Rober, Ashley; Tembulkar, Sahil; Graber, Kelsey; O’Donnell, Kyle; Hamoda, Hesham M.; Kimball, Kara; Rotenberg, Alexander; Oberman, Lindsay M.; Pascual-Leone, Alvaro; Keshavan, Matcheri S.; Duffy, Frank H.

    2016-01-01

    Background The N100 is a negative deflection in the surface EEG approximately 100ms after an auditory signal. It has been shown to be reduced in individuals with schizophrenia and those at clinical high risk (CHR). N100 blunting may index neural network dysfunction underlying psychotic symptoms. This phenomenon has received little attention in pediatric populations. Method This cross-sectional study compared the N100 response measured via the average EEG response at the left medial frontal position FC1 to 150 sinusoidal tones in participants ages 5 to 17 years with a CHR syndrome (n = 29), a psychotic disorder (n = 22), or healthy controls (n=17). Results Linear regression analyses that considered potential covariates (age, gender, handedness, family mental health history, medication usage) revealed decreasing N100 amplitude with increasing severity of psychotic symptomatology from healthy to CHR to psychotic level. Conclusions Longitudinal assessment of the N100 in CHR children who do and do not develop psychosis will inform whether it predicts transition to psychosis and if its response to treatment predicts symptom change. PMID:26549629

  3. IUE observations of HL CMa and the winds of cataclysmic variables

    NASA Technical Reports Server (NTRS)

    Mauche, C. W.; Raymond, J. C.

    1987-01-01

    As evidenced by the P Cygni profiles of their ultraviolet resonance lines, cataclysmic variables - like early-type stars - are known to have extensive, high velocity winds. Assisted by AAVSO visual data and IUE ultraviolet spectra, an observational and theoretical study of the P Cygni profiles of the dwarf nova HL CMa is presented. As these profiles are dependent upon the ionization structure of the wind, a model of a radiatively-driven shocked wind for cataclysmic variables is described, and results for the temperature and ionization structure of the outflowing gas are presented.

  4. Pediatric ultrasonography

    SciTech Connect

    Hayden, C.K. Jr.; Swischuk, L.E.

    1987-01-01

    Two leading experts explore the benefits and limitations of pediatric ultrasonography, explaining the latest techniques for optimal imaging of specific body regions: the head, chest, abdomen, pelvis, extremities, and soft tissues. Numerous illustrations emphasize significant points and combine with the text to show specifically what to look for when imaging children.

  5. Capability of Neutrophils to Form NETs Is Not Directly Influenced by a CMA-Targeting Peptide

    PubMed Central

    Maueröder, Christian; Schall, Nicolas; Meyer, Frédéric; Mahajan, Aparna; Garnier, Benjamin; Hahn, Jonas; Kienhöfer, Deborah; Hoffmann, Markus H.; Muller, Sylviane

    2017-01-01

    During inflammatory reaction, neutrophils exhibit numerous cellular and immunological functions, notably the formation of neutrophil extracellular traps (NETs) and autophagy. NETs are composed of decondensed chromatin fibers coated with various antimicrobial molecules derived from neutrophil granules. NETs participate in antimicrobial defense and can also display detrimental roles and notably trigger some of the immune features of systemic lupus erythematosus (SLE) and other autoimmune diseases. Autophagy is a complex and finely regulated mechanism involved in the cell survival/death balance that may be connected to NET formation. To shed some light on the connection between autophagy and NET formation, we designed a number of experiments in human neutrophils and both in normal and lupus-prone MRL/lpr mice to determine whether the synthetic peptide P140, which is capable of selectively modulating chaperone-mediated autophagy (CMA) in lymphocytes, could alter NET formation. P140/Lupuzor™ is currently being evaluated in phase III clinical trials involving SLE patients. Overall our in vitro and in vivo studies established that P140 does not influence NET formation, cytokine/chemokine production, or CMA in neutrophils. Thus, the beneficial effect of P140/Lupuzor™ in SLE is apparently not directly related to modulation of neutrophil function. PMID:28191006

  6. Capability of Neutrophils to Form NETs Is Not Directly Influenced by a CMA-Targeting Peptide.

    PubMed

    Maueröder, Christian; Schall, Nicolas; Meyer, Frédéric; Mahajan, Aparna; Garnier, Benjamin; Hahn, Jonas; Kienhöfer, Deborah; Hoffmann, Markus H; Muller, Sylviane

    2017-01-01

    During inflammatory reaction, neutrophils exhibit numerous cellular and immunological functions, notably the formation of neutrophil extracellular traps (NETs) and autophagy. NETs are composed of decondensed chromatin fibers coated with various antimicrobial molecules derived from neutrophil granules. NETs participate in antimicrobial defense and can also display detrimental roles and notably trigger some of the immune features of systemic lupus erythematosus (SLE) and other autoimmune diseases. Autophagy is a complex and finely regulated mechanism involved in the cell survival/death balance that may be connected to NET formation. To shed some light on the connection between autophagy and NET formation, we designed a number of experiments in human neutrophils and both in normal and lupus-prone MRL/lpr mice to determine whether the synthetic peptide P140, which is capable of selectively modulating chaperone-mediated autophagy (CMA) in lymphocytes, could alter NET formation. P140/Lupuzor™ is currently being evaluated in phase III clinical trials involving SLE patients. Overall our in vitro and in vivo studies established that P140 does not influence NET formation, cytokine/chemokine production, or CMA in neutrophils. Thus, the beneficial effect of P140/Lupuzor™ in SLE is apparently not directly related to modulation of neutrophil function.

  7. Searching for Cool Dust in the Mid-to-Far Infrared: The Mass Loss Histories of the Hypergiants mu Cep, VY CMa, IRC +10420, and rho Cas

    NASA Astrophysics Data System (ADS)

    Humphreys, Roberta M.

    2016-01-01

    The most massive cool stars near the empircal upper limit of luminosity on the HR Diagram shed mass during brief, intense periods of enhanced mass loss. Their circumstellar environments show extensive and complex ejecta in scattered light at visual wavelengths. In the infrared, thermal emission from cooler dust in their ejecta can be used as a tracers of their mass loss histories. We combine high-resolution adaptive optics imaging from MMT/MIRAC (8 - 12 µm) with the new capabilities in far-infrared imaging of SOFIA/FORCAST and Herschel/PACS to probe further into the past for evidence of earlier mass loss for four famous objects: the red supergiants mu Cep and VY CMa and the yellow hypergiants IRC +10420 and rho Cas. We find evidence for a variable mass loss rate over several thousand years for mu Cep, while in contrast the lack of extended cold dust beyond VY CMa's visible ejecta indicates that its high mass loss episodes are recent. Despite its history of episodic mass loss, rho Cas has no resolved circumstellar ejecta. The new long wavelength photometry from FORCAST, however, confirms the presence of a slowly expanding dust shell from its 1946 event

  8. "Don't let others design your future", new CMA president tells physicians. Interview by Nancy Robb.

    PubMed Central

    Kazimirski, J

    1996-01-01

    Dr. Judith Kazimirski of Nova Scotia becomes the CMA's 126th president during the association's annual meeting in Sydney, NS, this month. She says her priority for the next year is to help the CMA play a lead role as the debate intensifies about the future of health and health care in Canada. "The time is right for a very public debate about what people want their system to be, what problems they're having, and how reform is moving ahead," she says, "and physicians have a critical leadership role to play." Images p452-a PMID:8801012

  9. VizieR Online Data Catalog: VY CMa ALMA NaCl images (Decin+, 2016)

    NASA Astrophysics Data System (ADS)

    Decin, L.; Richards, A. M. S.; Millar, T. J.; Baudry, A.; de Beck, E.; Homan, W.; Smith, N.; van de Sande, M.; Walsh, C.

    2016-07-01

    VY CMa was observed for ALMA Science Verification on 2013 16-19 August using 16-20 12-m antennas on baselines from 0.014-2.7km. The main objective was to map the H2O maser lines at 321 and 325GHz (Band 7) and 658GHz (Band 9), but several thermal lines identified with various rotational transitions of NaCl, TiO2, SO2, and SiO were also present in the spectral setting in addition to the continuum data. Four NaCl lines in the ground or first vibrational state are covered in the ALMA band 7 data. All of them are detected, albeit only two are unblended (see Table 1). (3 data files).

  10. SEARCH FOR A MAGNETIC FIELD VIA CIRCULAR POLARIZATION IN THE WOLF-RAYET STAR EZ CMa

    SciTech Connect

    De la Chevrotiere, A.; St-Louis, N.; Moffat, A. F. J.; Collaboration: MiMeS Collaboration

    2013-02-20

    We report on the first deep, direct search for a magnetic field via the circular polarization of Zeeman splitting in a Wolf-Rayet (W-R) star. Using the highly efficient ESPaDOnS spectropolarimeter at the Canada-France-Hawaii Telescope, we observed at three different epochs one of the best W-R candidates in the sky expected to harbor a magnetic field, the bright, highly variable WN4 star EZ CMa = WR6 = HD 50896. We looked for the characteristic circular polarization (Stokes V) pattern in strong emission lines that would arise as a consequence of a global, rotating magnetic field with a split monopole configuration. We also obtained nearly simultaneous linear polarization spectra (Stokes Q and U), which are dominated by electron scattering, most likely from a flattened wind with large-scale corotating structures. As the star rotates with a period of 3.766 days, our view of the wind changes, which in turn affects the value of the linear polarization in lines versus continuum at the {approx}0.2% level. Depending on the epoch of observation, our Stokes V data were affected by significant crosstalk from Stokes Q and U to V. We removed this spurious signal from the circular polarization data and experimented with various levels of spectral binning to increase the signal-to-noise ratio of our data. In the end, no magnetic field is unambiguously detected in EZ CMa. Assuming that the star is intrinsically magnetic and harbors a split monopole configuration, we find an upper limit of B {approx} 100 G for the intensity of its field in the line-forming regions of the stellar wind.

  11. Control of coal combustion SO[sub 2] and NO[sub x] emissions by in-boiler injection of CMA

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.

    1992-01-01

    The principal objectives of the proposed research are two-fold: (A) To understand the mechanism and assess the effectiveness of sulfur capture by the chemical calcium magnesium acetate (CMA). And (B) To evaluate the NO[sub x] reduction capabilities of CMA by burning the organic constituents of the chemical (the acetate) and reducing NO to stable N[sub 2] The optimum conditions and the location of CMA introduction in the furnace will be identified. To achieve these goals water solutions of CMA or dry powders of CMA will be injected into hot air or gases simulating the furnace exhaust (containing CO[sub 2], SO[sub x] NO[sub x], H[sub 2]O, O[sub 2] etc.) and the composition of gaseous and solid products of the reaction will be monitored. The processes of burning the organic acetate as well as the calcination, sintering and sulfation of the remaining solid will be studied in detail.

  12. Disease-associated pathophysiologic structures in pediatric rheumatic diseases show characteristics of scale-free networks seen in physiologic systems: implications for pathogenesis and treatment

    PubMed Central

    Frank, Mark Barton; Wang, Shirley; Aggarwal, Amita; Knowlton, Nicholas; Jiang, Kaiyu; Chen, Yanmin; McKee, Ryan; Chaser, Brad; McGhee, Timothy; Osban, Jeanette; Jarvis, James N

    2009-01-01

    Background While standard reductionist approaches have provided some insights into specific gene polymorphisms and molecular pathways involved in disease pathogenesis, our understanding of complex traits such as atherosclerosis or type 2 diabetes remains incomplete. Gene expression profiling provides an unprecedented opportunity to understand complex human diseases by providing a global view of the multiple interactions across the genome that are likely to contribute to disease pathogenesis. Thus, the goal of gene expression profiling is not to generate lists of differentially expressed genes, but to identify the physiologic or pathogenic processes and structures represented in the expression profile. Methods RNA was separately extracted from peripheral blood neutrophils and mononuclear leukocytes, labeled, and hybridized to genome level microarrays to generate expression profiles of children with polyarticular juvenile idiopathic arthritis, juvenile dermatomyositis relative to childhood controls. Statistically significantly differentially expressed genes were identified from samples of each disease relative to controls. Functional network analysis identified interactions between products of these differentially expressed genes. Results In silico models of both diseases demonstrated similar features with properties of scale-free networks previously described in physiologic systems. These networks were observable in both cells of the innate immune system (neutrophils) and cells of the adaptive immune system (peripheral blood mononuclear cells). Conclusion Genome-level transcriptional profiling from childhood onset rheumatic diseases suggested complex interactions in two arms of the immune system in both diseases. The disease associated networks showed scale-free network patterns similar to those reported in normal physiology. We postulate that these features have important implications for therapy as such networks are relatively resistant to perturbation. PMID

  13. Pediatric Specialists

    MedlinePlus

    ... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & ... is a Pediatric Rheumatologist? What is a Pediatric Sports Medicine Specialist? What is a Pediatric Surgeon? What is a Pediatric Transport ... Find Us Donate Contact ...

  14. Gemini VRI data of counterparts associated to X-ray sources in CMa R1

    NASA Astrophysics Data System (ADS)

    Gregorio-Hetem, J.; Rodrigues, C. V.; Montmerle, T.

    The molecular cloud Canis Major R1 (CMa R1) contains several embedded stellar clusters associated to a ring of nebular emission, which is an expanding shell suggested to be a supernova remnant (SNR) inducing the star formation in this region (Herbst & Assousa 1977, Comerón et al. 1998). However, there are alternatives to the SNR hypothesis, since the shell-like structure could be produced by strong stellar winds or an evolving HII region, as suggested by Reynolds & Ogden (1978), Blitz (1980), and Pyatunina & Taraskin (1986), for example. Two main challenges have motivated us to investigate this interesting region: (i) to conduct a stellar population study, from 7 to 0.4 solar masses, and (ii) to verify the evolutionary status of embedded cluster members. This contribution is dedicated to report VRI data obtained with Gemini South telescope in the direction of X-ray sources for which no counterpart had been previously identified. The Gemini imaging was performed for six fields revealing several faint candidates that are probably multiple counterparts of X-ray emitters detected by ROSAT as single sources (Gregorio-Hetem, Montmerle & Marciotto 2003). These fields have not been observed in more recent X-ray surveys. The V-R and R-I colours were estimated for the objects associated with the position of the X-ray emission, aiming to distinguish between field stars and members of the cloud. The 2MASS catalogue was inspected searching for near-infrared (NIR) counterparts related to the optical candidates. Each ROSAT source has 6 to 16 possible optical counterparts, 67% to 86% of them being NIR sources. Colour-colour and colour-magnitude diagrams have been constructed to evaluate the evolutionary status of the stellar groups. Investigating the evolutionary scenario of the embedded stellar clusters associated to X-ray emitters, which are probably very young, is a unique opportunity to better understand the star formation process in CMa R1 and to test SNR models, verifying

  15. Time-Dependent Spectral Feature Variations of the FS CMa Star HD 50138

    NASA Astrophysics Data System (ADS)

    Jeřábková, T.; Korčáková, D.; Miroshnichenko, A. S.; Danford, S.; Zharikov, S. V.; Kříček, R.; Zasche, P.; Votruba, V.; Šlechta, M.; Škoda, P.; Janík, J.

    2017-02-01

    HD 50138 (V743 Mon, MWC 158, or IRAS 06491-0654) is a B[e] star of the FS CMa type. It is supposed to be a post-main-sequence star, which is still not highly evolved. The presence of a gaseous and dusty envelope precludes direct observations of the central object, and the possible binarity and physical nature of HD 50138 remains unclear. We present a long-term spectroscopic monitoring of this object over the last 20 years (Jeřábková et al. 2016). Based on the obtained data, we confirm a quasi-periodic behavior of the object's spectral variability with two newly found long periods manifested in the Hα and forbidden [O I] lines. The rotating structures around the object are supported by the detection of moving humps in the Hα profile. Our results are consistent with either mass transfer in a binary system or the presence of an outflowing disk. Since our data cannot confirm the presence of a binary companion, the origin of such systems remains an interesting problem for further investigation.

  16. ITC-CMA partnership and data needs for alkylphenols and ethoxylates

    USGS Publications Warehouse

    Rattner, B.A.; Rice, C.P.; Walker, J.D.

    1996-01-01

    The ITC has been an independent advisory committee to the EPA Administrator since enactment of the Toxics Substances Control Act (TSCA) in 1976. The ITC identifies and coordinates U.S. Government data needs for TSCA-regulable chemicals, and makes recommendations to the Administrator for priority testing consideration. Chemicals recommended by the ITC are added to the TSCA Priority Testing List that is revised semi-annually in Reports to the Administrator. In recent Reports, the ITC added alkylphenols (APs) and ethoxylates to the Priority Testing List. About 500 million pounds are produced annually for industrial processing, cleaning and personal care products. APs have been detected in the tissues of fish from the Great Lakes, and one AP (nonylphenol) causes vitellogenin gene expression in trout hepatocytes. Numerous APs and ethoxylates were recommended by the ITC because data are needed on: (1) chemical composition, (2) environmental fate of parent chemicals and impurities, and (3) health and ecological effects (including toxicokinetics and endocrine-modulating effects). In response to the ITC's recommendations, two activities have ensued. First, the EPA promulgated rules requiring manufacturers, importers and processors of APs and ethoxylates to submit production and exposure reports, and unpublished health and safety studies, for review. Second, the Alkylphenols and Ethoxylates Panel of Chemical Manufacturers Association (CMA) and the ITC formed a Dialogue Group to discuss the data needs. Data needs and activities initiated by the Dialogue Group will be presented.

  17. Pediatric sedation.

    PubMed

    Daud, Yasmeen N; Carlson, Douglas W

    2014-08-01

    Pediatric sedation is an evolving field performed by an extensive list of specialties. Well-defined sedation systems within pediatric facilities are paramount to providing consistent, safe sedation. Pediatric sedation providers should be trained in the principles and practice of sedation, which include patient selection, pre-sedation assessment to determine risks during sedation, selection of optimal sedation medication, monitoring requirements, and post-sedation care. Training, credentialing, and continuing sedation education must be incorporated into sedation systems to verify and monitor the practice of safe sedation. Pediatric hospitalists represent a group of providers with extensive pediatric knowledge and skills who can safely provide pediatric sedation.

  18. Pediatric MS

    MedlinePlus

    ... is diagnosed with MS. Learn More Learn More Network of Pediatric MS Centers The National MS Society ... MS Study Group (2004) and established a nationwide network of six Pediatric MS Centers of Excellence (2006) ...

  19. Pediatric Asthma

    MedlinePlus

    ... Research & Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask ... Ask a Question The first symptoms of childhood asthma – heavy wheezing, tight chest and shortness of breath – ...

  20. Myocarditis - pediatric

    MedlinePlus

    ... 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 ...

  1. Pediatric Injury

    MedlinePlus

    ... Control and Prevention’s Safe Child website . What is pediatric critical care? Children who have severe or life-threatening injuries ... are staffed by physicians with specialized training in pediatric critical care medicine ("pediatric intensivists"). Because children can experience a ...

  2. Economics of pediatric burns.

    PubMed

    Bass, Michael J; Phillips, Linda G

    2008-07-01

    Sustaining a burn injury sets in motion a cycle of pain, disfigurement, and a search for survival. In pediatric burns, the injury extends to the parents where fear, ignorance, and helplessness forever change their lives. Pediatric burn injuries are caused by fire, hot liquids, clothing irons, hair curlers, caustic substances like drain cleaner, the grounding of an electrical source, and exposure to radiation. Efficiency in the delivery of pediatric burn care is critical. Maximizing resource utilization means continual self-evaluation and economic analysis of therapeutic modalities. Griffiths et al found that most childhood burns are due to scalds, which can be treated for $1061 per percent burn. Paddock et al reduced the cost of treating superficial pediatric burns and reduced the length of stay in hospital using silver-impregnated gauze over traditional methods. Barrett et al found improved cosmesis of skin grafts using cultured epithelial autografts but at a substantially increased cost. Corpron et al showed that pediatric burn units that treat burns >10% total body surface area and operative treatment of pediatric burns regardless of size generate positive revenue. There is a paucity of evidentiary pediatric burn economic data. More research is needed to address areas of pediatric burn care inefficiency. Improving knowledge of cost in all health care endeavors will create competition and drive down expenditures.

  3. Additional information from chromosomal microarray analysis (CMA) over conventional karyotyping when diagnosing chromosomal abnormalities in miscarriage: a systematic review and meta-analysis.

    PubMed

    Dhillon, R K; Hillman, S C; Morris, R K; McMullan, D; Williams, D; Coomarasamy, A; Kilby, M D

    2014-01-01

    Approximately 50% of spontaneous miscarriages are associated with chromosome abnormalities. Identification of these karyotypic abnormalities helps to estimate recurrence risks in future pregnancies. Chromosomal microarray analysis (CMA) is transforming clinical cytogenetic practice with its ability to examine the human genome at increasingly high resolution. The aim of this study was to determine whether CMA testing on the products of conception following miscarriage provides better diagnostic information compared with conventional karyotyping. MEDLINE (from 1996 to December 2012), EMBASE (from 1974 to December 2012), and CINAHL (from 1996 to December 2012) databases were searched electronically. Studies were selected if CMA was used on products of conception following miscarriage, alongside conventional karyotyping. Nine papers were included in the systematic review and meta-analysis. All statistical analyses were performed using stata 11.0 (Stata Corp., College Station, TX, USA). There was agreement between CMA and karyotyping in 86.0% of cases (95% CI 77.0-96.0%). CMA detected 13% (95% CI 8.0-21.0) additional chromosome abnormalities over conventional full karyotyping. In addition, traditional, full karyotyping detected 3% (95% CI 1.0-10.0%) additional abnormalities over CMA. The incidence of a variant of unknown significance (VOUS) being detected was 2% (95% CI 1.0-10.0%). Compared with karyotyping, there appears to be an increased detection rate of chromosomal abnormalities when CMA is used to analyse the products of conception; however, some of these abnormalities are VOUS, and this information should be provided when counselling women following miscarriage and when taking consent for the analysis of miscarriage products by CMA. © 2013 RCOG.

  4. RED SUPERGIANTS AS POTENTIAL TYPE IIn SUPERNOVA PROGENITORS: SPATIALLY RESOLVED 4.6 {mu}m CO EMISSION AROUND VY CMa AND BETELGEUSE

    SciTech Connect

    Smith, Nathan; Hinkle, Kenneth H.; Ryde, Nils E-mail: hinkle@noao.edu

    2009-03-15

    We present high-resolution 4.6 {mu}m CO spectra of the circumstellar environments of two red supergiants (RSGs) that are potential supernova (SN) progenitors: Betelgeuse and VY Canis Majoris (VY CMa). Around Betelgeuse, {sup 12}CO emission within {+-}3'' ({+-}12 km s{sup -1}) follows a mildly clumpy but otherwise spherical shell, smaller than its {approx}55'' shell in K I {lambda}7699. In stark contrast, 4.6 {mu}m CO emission around VY CMa is coincident with bright K I in its clumpy asymmetric reflection nebula, within {+-}5'' ({+-}40 km s{sup -1}) of the star. Our CO data reveal redshifted features not seen in K I spectra of VY CMa, indicating a more isotropic distribution of gas punctuated by randomly distributed asymmetric clumps. The relative CO and K I distribution in Betelgeuse arises from ionization effects within a steady wind, whereas in VY CMa, K I is emitted from skins of CO cloudlets resulting from episodic mass ejections 500-1000 yr ago. In both cases, CO and K I trace potential pre-SN circumstellar matter: we conclude that an extreme RSG like VY CMa might produce a Type IIn event like SN 1988Z if it were to explode in its current state, but Betelgeuse will not. VY CMa demonstrates that luminous blue variables are not necessarily the only progenitors of SNe IIn, but it underscores the requirement that SNe IIn suffer enhanced episodic mass loss shortly before exploding.

  5. Sub-0.1'' optical imaging of the Z CMa jets with SPHERE/ZIMPOL

    NASA Astrophysics Data System (ADS)

    Antoniucci, S.; Podio, L.; Nisini, B.; Bacciotti, F.; Lagadec, E.; Sissa, E.; La Camera, A.; Giannini, T.; Schmid, H. M.; Gratton, R.; Turatto, M.; Desidera, S.; Bonnefoy, M.; Chauvin, G.; Dougados, C.; Bazzon, A.; Thalmann, C.; Langlois, M.

    2016-09-01

    Context. Crucial information on the mass accretion-ejection connection in young stars can be obtained from high spatial resolution images of jets in sources with known recurrent accretion outbursts. Aims: Using the VLT/SPHERE ZIMPOL instrument, we observed the young binary Z CMa that is composed of a Herbig Be star and a FUor object, both driving a jet. We aim to analyse the structure of the two jets, their relation with the properties of the driving sources, and their connection with previous accretion events observed in this target. Methods: We obtained optical images in the Hα and [O i] 6300 Å lines at the unprecedented angular resolution of ~0.03 arcsec, on which we have performed both continuum subtraction and deconvolution, thereby deriving results that are consistent with each other. Results: Our images reveal extended emission from both sources: a fairly compact and poorly collimated emission SW of the Herbig component and an extended collimated and precessing jet from the FUor component. The compact emission from the Herbig star is compatible with a wide-angle wind and is possibly connected to the recent outburst events shown by this component. The FUor jet is traced down to 70 mas (80 AU) from the source and is highly collimated with a width of 26-48 AU at distances 100-200 AU, which is similar to the width of jets from T Tauri stars. This strongly suggests that the same magneto-centrifugal jet-launching mechanism also operates in FUors. The observed jet wiggle can be modelled as originating from an orbital motion with a period of 4.2 yr around an unseen companion with mass between 0.48 and 1 M⊙. The jet mass loss rate Ṁjet was derived from the [O i] luminosity and comprises of between 1 × 10-8 and 1 × 10-6M⊙ yr-1. This is the first direct Ṁjet measurement from a jet in a FUor. If we assume previous mass accretion rate estimates obtained through modelling of the accretion disk, the derived range of Ṁjet would imply a very low mass

  6. CONSTRAINTS ON THE SURFACE MAGNETIC FIELDS AND AGE OF A COOL HYPERGIANT: XMM-NEWTON X-RAY OBSERVATIONS OF VY CMa

    SciTech Connect

    Montez, Rodolfo Jr.; Kastner, Joel H.; Humphreys, Roberta M.; Davidson, Kris; Turok, Rebecca L. E-mail: jhk@cis.rit.edu

    2015-02-10

    The complex circumstellar ejecta of highly evolved, cool hypergiants are indicative of multiple, asymmetric mass-loss events. To explore whether such episodic, non-isotropic mass loss may be driven by surface magnetic activity, we have observed the archetypical cool hypergiant VY CMa with the XMM-Newton X-ray satellite observatory. The hypergiant itself is not detected in these observations. From the upper limit on the X-ray flux from VY CMa at the time of our observations (F {sub X,} {sub UL} ≈ 8 × 10{sup –14} erg cm{sup –2} s{sup –1}, corresponding to log L{sub X} /L {sub bol} ≤ –8), we estimate an average surface magnetic field strength fB ≤ 2 × 10{sup –3} G (where f is the filling factor of magnetically active surface regions). These X-ray results for VY CMa represent the most stringent constraints to date on the magnetic field strength near the surface of a hypergiant. VY CMa's mass loss is episodic, however, and the hypergiant may have been in a state of low surface magnetic activity during the XMM observations. The XMM observations also yield detections of more than 100 X-ray sources within ∼15' of VY CMa, roughly 50 of which have near-infrared counterparts. Analysis of X-ray hardness ratios and IR colors indicates that some of these field sources may be young, late-type stars associated with VY CMa, its adjacent molecular cloud complex, and the young cluster NGC 2362. Further study of the VY CMa field is warranted, given the potential to ascertain the evolutionary timescale of this enigmatic, massive star.

  7. Constraints on the Surface Magnetic Fields and Age of a Cool Hypergiant: XMM-Newton X-Ray Observations of VY CMa

    NASA Astrophysics Data System (ADS)

    Montez, Rodolfo, Jr.; Kastner, Joel H.; Humphreys, Roberta M.; Turok, Rebecca L.; Davidson, Kris

    2015-02-01

    The complex circumstellar ejecta of highly evolved, cool hypergiants are indicative of multiple, asymmetric mass-loss events. To explore whether such episodic, non-isotropic mass loss may be driven by surface magnetic activity, we have observed the archetypical cool hypergiant VY CMa with the XMM-Newton X-ray satellite observatory. The hypergiant itself is not detected in these observations. From the upper limit on the X-ray flux from VY CMa at the time of our observations (F X, UL ≈ 8 × 10-14 erg cm-2 s-1, corresponding to log LX /L bol <= -8), we estimate an average surface magnetic field strength fB <= 2 × 10-3 G (where f is the filling factor of magnetically active surface regions). These X-ray results for VY CMa represent the most stringent constraints to date on the magnetic field strength near the surface of a hypergiant. VY CMa's mass loss is episodic, however, and the hypergiant may have been in a state of low surface magnetic activity during the XMM observations. The XMM observations also yield detections of more than 100 X-ray sources within ~15' of VY CMa, roughly 50 of which have near-infrared counterparts. Analysis of X-ray hardness ratios and IR colors indicates that some of these field sources may be young, late-type stars associated with VY CMa, its adjacent molecular cloud complex, and the young cluster NGC 2362. Further study of the VY CMa field is warranted, given the potential to ascertain the evolutionary timescale of this enigmatic, massive star.

  8. Pediatric Sepsis.

    PubMed

    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.

  9. Cytogenetic analyses using C-banding and DAPI/CMA3 staining of four populations of the maize weevil Sitophilus zeamais Motschulsky, 1855 (Coleoptera, Curculionidae)

    PubMed Central

    da Silva, Alexandra A.; Braga, Lucas S.; Guedes, Raul Narciso C.; Tavares, Mara G.

    2015-01-01

    Abstract Cytogenetic data avalaible for the maize weevil Sitophilus zeamais Motschulsky, 1855 (Coleoptera: Curculionidae), one of the most destructive pests of stored cereal grains, are controversial. Earlier studies focused on single populations and emphasized chromosome number and sex determination system. In this paper, the karyotypes of four populations of Sitophilus zeamais were characterized by conventional staining, C-banding and sequential staining with the fluorochromes chromomycin-A3/4-6-diamidino-2-phenylindole (CMA3/DAPI). The analyses of metaphases obtained from the cerebral ganglia of last instar larvae and the testes of adults showed that the species had 2n = 22 chromosomes, with 10 autosomal pairs and a sex chromosome pair (XX in females and Xyp in males). Chromosome number, however, ranged from 2n = 22 to 26 due to the presence of 0–4 supernumerary chromosomes in individuals from the populations of Viçosa, Unai and Porto Alegre. With the exception of the Y chromosome, which was dot-like, all other chromosomes of this species were metacentric, including the supernumeraries. The heterochromatin was present in the centromeric regions of all autosomes and in the centromere of the X chromosome. The B chromosomes were partially or totally heterochromatic, and the Y chromosome was euchromatic. The heterochromatic regions were labeled with C-banding and DAPI, which showed that they were rich in AT base pairs. PMID:25893077

  10. Karyotype diversity of four species of the incertae sedis group (Characidae) from different hydrographic basins: analysis of AgNORs, CMA3 and 18S rDNA.

    PubMed

    Mendes, M M; da Rosa, R; Giuliano-Caetano, L; Dias, A L

    2011-11-22

    A large number of genera in the tropical fish family Characidae are incertae sedis. Cytogenetic analysis was made of four of these species: Astyanax eigenmanniorum, Deuterodon stigmaturus, Hyphessobrycon luetkenii, and H. anisitsi, collected from various hydrographic basins: hydrographic system from Laguna dos Patos/RS, Tramandaí basin/RS and Tibagi River basin/PR. The first two species were collected in their type locality in the State of Rio Grande do Sul. The 2n = 48 karyotype was observed only in A. eigenmanniorum, while the other species had 2n = 50 chromosomes, with different karyotypic formulas. There was weak heterochromatin staining in the pericentromeric region of A. eigenmanniorum, D. stigmaturus and H. luetkenni chromosomes. In H. anisitsi, heterochromatin appeared to be more abundant and distributed in the pericentromeric and terminal regions of the chromosomes; three pairs showed more evident heterochromatic blocks. There were multiple Ag-NORs in all populations, visualized by FISH with an 18S rDNA probe. While D. stigmaturus and H. luetkenii had conserved AgNOR, CMA3 and 18S rDNA sites, the other two species showed intra- and interindividual variation at these sites. The karyotype variability was high, as is common in this group of fish. Different species arising from isolated hydrographic basins maintain an elevated level of karyotype differentiation, mainly with respect to chromosome structure, heterochromatin distribution and rDNA localization. This is the first report with cytogenetic data for D. stigmaturus and H. luetkenii.

  11. Cytogenetic analyses using C-banding and DAPI/CMA3 staining of four populations of the maize weevil Sitophiluszeamais Motschulsky, 1855 (Coleoptera, Curculionidae).

    PubMed

    da Silva, Alexandra A; Braga, Lucas S; Guedes, Raul Narciso C; Tavares, Mara G

    2015-01-01

    Cytogenetic data avalaible for the maize weevil Sitophiluszeamais Motschulsky, 1855 (Coleoptera: Curculionidae), one of the most destructive pests of stored cereal grains, are controversial. Earlier studies focused on single populations and emphasized chromosome number and sex determination system. In this paper, the karyotypes of four populations of Sitophiluszeamais were characterized by conventional staining, C-banding and sequential staining with the fluorochromes chromomycin-A3/4-6-diamidino-2-phenylindole (CMA3/DAPI). The analyses of metaphases obtained from the cerebral ganglia of last instar larvae and the testes of adults showed that the species had 2n = 22 chromosomes, with 10 autosomal pairs and a sex chromosome pair (XX in females and Xyp in males). Chromosome number, however, ranged from 2n = 22 to 26 due to the presence of 0-4 supernumerary chromosomes in individuals from the populations of Viçosa, Unai and Porto Alegre. With the exception of the Y chromosome, which was dot-like, all other chromosomes of this species were metacentric, including the supernumeraries. The heterochromatin was present in the centromeric regions of all autosomes and in the centromere of the X chromosome. The B chromosomes were partially or totally heterochromatic, and the Y chromosome was euchromatic. The heterochromatic regions were labeled with C-banding and DAPI, which showed that they were rich in AT base pairs.

  12. Holocentric chromosomes of psocids (Insecta, Psocoptera) analysed by C-banding, silver impregnation and sequence specific fluorochromes CMA3 and DAPI.

    PubMed

    Golub, Natalia V; Nokkala, Seppo; Kuznetsova, Valentina G

    2004-01-01

    The pattern of nucleolus attachment and C-heterochromatin distribution and molecular composition in the karyotypes of psocid species Psococerastis gibbosa (2n = 16+X), Blaste conspurcata (2n = 16+X) and Amphipsocus japonicus (2n = 14+neo-XY) were studied by C-banding, silver impregnation and sequence specific fluorochromes CMA3 and DAPI. Every species was found to have a single nucleolus in male meiosis. In P. gibbosa the nucleolus is attached to an autosomal bivalent; in B. conspurcata to the X-chromosome; in A. japonicus to the neo-XY bivalent. The species show a rather small amount of constitutive heterochromatin, C-blocks demonstrating telomeric localization with rare exceptions. P. gibbosa is characterized by a polymorphism for C-blocks occurrence and distribution. In the autosomes of this species, C-heterochromatin consists of AT-rich DNA except for the nucleolus organizing region, which is also GC-rich; the X-chromosome shows both AT- and GC-rich clusters. In A. japonicus and B. conspurcata, C-heterochromatin of the autosomes and sex chromosomes consists of both GC-rich and AT-rich DNA clusters, which are largely co-localized.

  13. Evolutionary chromosomal differentiation among four species of Conoderus Eschscholtz, 1829 (Coleoptera, Elateridae, Agrypninae, Conoderini) detected by standard staining, C-banding, silver nitrate impregnation, and CMA3/DA/DAPI staining.

    PubMed

    Schneider, Marielle Cristina; Almeida, Mara Cristina; Rosa, Simone Policena; Costa, Cleide; Cella, Doralice Maria

    2006-01-01

    The speciose Brazilian Elateridae fauna is characterized by high karyotypic diversity, including one species (Chalcolepidius zonatus Eschscholtz, 1829) with the lowest diploid number within any Coleoptera order. Cytogenetic analysis of Conoderus dimidiatus Germar, 1839, C. scalaris (Germar, 1824,) C. ternarius Germar, 1839, and C. stigmosus Germar, 1839 by standard and differential staining was performed with the aim of establishing mechanisms of karyotypic differentiation in these species. Conoderus dimidiatus, C. scalaris, and C. ternarius have diploid numbers of 2n(male) = 17 and 2n(female) = 18, and a X0/XX sex determination system, similar to that encountered in the majority of Conoderini species. The karyotype of C. stigmosus was characterized by a diploid number of 2n = 16 and a neoXY/neoXX sex determination system that was highly differentiated from other species of the genus. Some features of the mitotic and meiotic chromosomes suggest an autosome/ancestral X chromosome fusion as the cause of the neoXY system origin in C. stigmosus. C-banding and silver impregnation techniques showed that the four Conoderus species possess similar chromosomal characteristics to those registered in most Polyphaga species, including pericentromeric C band and autosomal NORs. Triple staining techniques including CMA3/DA/DAPI also provided useful information for differentiating these Conoderus species. These techniques revealed unique GC-rich heterochromatin associated with NORs in C. scalaris and C. stigmosus and CMA3-heteromorphism in C. scalaris and C. ternarius.

  14. Pediatric MS

    MedlinePlus

    ... video) Watch Video Students with MS and the Academic Setting: A Handbook for School Personnel (.pdf) Download Brochure Managing School-Related Issues: A Guide for Parents with a Child or Teen Living with MS (.pdf) Download Brochure Network of Pediatric MS Centers Learn More Pediatric MS ...

  15. Karyotype analysis of four jewel-beetle species (Coleoptera, Buprestidae) detected by standard staining, C-banding, AgNOR-banding and CMA3/DAPI staining.

    PubMed

    Karagyan, Gayane; Lachowska, Dorota; Kalashian, Mark

    2012-01-01

    The male karyotypes of Acmaeodera pilosellae persica Mannerheim, 1837 with 2n=20 (18+neoXY), Sphenoptera scovitzii Faldermann, 1835 (2n=38-46), Dicerca aenea validiuscula Semenov, 1895 - 2n=20 (18+Xyp) and Sphaerobothris aghababiani Volkovitsh et Kalashian, 1998 - 2n=16 (14+Xyp) were studied using conventional staining and different chromosome banding techniques: C-banding, AgNOR-banding, as well as fluorochrome Chromomycin A3 (CMA3) and DAPI. It is shown that C-positive segments are weakly visible in all four species which indicates a small amount of constitutive heterochromatin (CH). There were no signals after DAPI staining and some positive signals were discovered using CMA3 staining demonstrating absence of AT-rich DNA and presence of GC-rich clusters of CH. Nucleolus organizing regions (NORs) were revealed using Ag-NOR technique; argentophilic material mostly coincides with positive signals obtained using CMA3 staining.

  16. Karyotype analysis of four jewel-beetle species (Coleoptera, Buprestidae) detected by standard staining, C-banding, AgNOR-banding and CMA3/DAPI staining

    PubMed Central

    Karagyan, Gayane; Lachowska, Dorota; Kalashian, Mark

    2012-01-01

    Abstract The male karyotypes of Acmaeodera pilosellae persica Mannerheim, 1837 with 2n=20 (18+neoXY), Sphenoptera scovitzii Faldermann, 1835 (2n=38–46), Dicerca aenea validiuscula Semenov, 1895 – 2n=20 (18+Xyp) and Sphaerobothris aghababiani Volkovitsh et Kalashian, 1998 – 2n=16 (14+Xyp) were studied using conventional staining and different chromosome banding techniques: C-banding, AgNOR-banding, as well as fluorochrome Chromomycin A3 (CMA3) and DAPI. It is shown that C-positive segments are weakly visible in all four species which indicates a small amount of constitutive heterochromatin (CH). There were no signals after DAPI staining and some positive signals were discovered using CMA3 staining demonstrating absence of AT-rich DNA and presence of GC-rich clusters of CH. Nucleolus organizing regions (NORs) were revealed using Ag-NOR technique; argentophilic material mostly coincides with positive signals obtained using CMA3 staining. PMID:24260661

  17. Virtual Pediatric Hospital

    MedlinePlus

    ... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

  18. Pediatric Cardiomyopathies.

    PubMed

    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

  19. AB024. Chromosome microarray analysis (CMA) for the diagnosis of children with developmental delay and multiple congenital anomalies in Singapore

    PubMed Central

    Law, Hai-Yang; Brett, Maggie; Tan, Ene-Choo; Yong, Min-Hwee; Lai, Angeline

    2015-01-01

    Chromosome microarray analysis (CMA) is a sensitive method to identify submicroscopic changes too small to be detected by conventional karyotyping. Due to its high-sensitivity in identifying regions with structural variation and hence the genes involved, it is recommended to be the first-tier genetic test for children with intellectual disabilities, development delay or multiple congenital anomalies, and is routinely available in USA and many countries in Europe. Our lab has started offering this as a clinical test based on the research experience on screening >400 children with developmental delay and multiple congenital anomalies since February 2014. To date, 271 patients have been screened using the Agilent 4×180K CGH + SNP array. Copy number variants (CNVs) ranging in size from 10 kb to 154 Mb were found in 109 patients (40%). Pathogenic and likely pathogenic CNVs were found in 55 (20%). These included 45 with deletions, 8 with duplications and 2 patients with both deletion and duplication. Recurrent microdeletion and microduplication syndromes including the Angelman/Prader-Willi syndrome [5], 1p36 microdeletion [3], Williams syndrome [2], 22q11.2 distal deletion syndrome [2], 16p13.3 microdeletion syndrome [2], Cat Eye syndrome, Cri du Chat syndrome, Miller Decker syndrome, 3q29 microdeletion, 15q24 microdeletion, and 1q43q44 syndrome were among the variants detected in our patients. CNVs of uncertain clinical significance were detected in 54 (20%) individuals: 32 were duplications, 18 were deletions and one with both deletion and duplication. However, due to the high cost of the test, parental testing was not performed and hence, significance of these variants could not be established conclusively. In conclusion, CMA is a powerful tool in identifying pathogenic chromosomal copy number alternations. However, due to the high cost of the test, parental testing for the cases where variants of uncertain significant are found is often not possible. CMA is useful

  20. "The Show"

    ERIC Educational Resources Information Center

    Gehring, John

    2004-01-01

    For the past 16 years, the blue-collar city of Huntington, West Virginia, has rolled out the red carpet to welcome young wrestlers and their families as old friends. They have come to town chasing the same dream for a spot in what many of them call "The Show". For three days, under the lights of an arena packed with 5,000 fans, the…

  1. "The Show"

    ERIC Educational Resources Information Center

    Gehring, John

    2004-01-01

    For the past 16 years, the blue-collar city of Huntington, West Virginia, has rolled out the red carpet to welcome young wrestlers and their families as old friends. They have come to town chasing the same dream for a spot in what many of them call "The Show". For three days, under the lights of an arena packed with 5,000 fans, the…

  2. Pediatric Terminology

    Cancer.gov

    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

  3. Molecular characterization of constitutive heterochromatin in three species of Trypoxylon (Hymenoptera: Crabronidae: Trypoxylini) by CMA3/DAPI staining

    PubMed Central

    Menezes, Rodolpho Santos Telles; Carvalho, Antonio Freire; Silva, Janisete Gomes; Costa, Marco Antonio

    2011-01-01

    Abstract Previous cytogenetic analyses in Trypoxylon Latreille, 1796 have been basically restricted to C-banding. In the present study, base-specific CMA3 and DAPI fluorochrome staining were used to characterize the constitutive heterochromatin in three Trypoxylon species. The heterochromatin was GC-rich in all the species studied; however, in Trypoxylon nitidum F. Smith, 1856the molecular composition of the heterochromatinwasdifferent among chromosome pairs. Conversely, the euchromatin was AT-rich in the three species. These results suggest high conservatism in the euchromatic regions as opposed to the heterochromatic regions that have a high rate of changes. In this study, we report the karyotype of Trypoxylon rugifrons F. Smith, 1873which has the lowest chromosome number in the genus and other characteristics of the likely ancestral Trypoxylon karyotype. PMID:24260620

  4. Molecular characterization of constitutive heterochromatin in three species of Trypoxylon (Hymenoptera: Crabronidae: Trypoxylini) by CMA3/DAPI staining.

    PubMed

    Menezes, Rodolpho Santos Telles; Carvalho, Antonio Freire; Silva, Janisete Gomes; Costa, Marco Antonio

    2011-01-01

    Previous cytogenetic analyses in Trypoxylon Latreille, 1796 have been basically restricted to C-banding. In the present study, base-specific CMA3 and DAPI fluorochrome staining were used to characterize the constitutive heterochromatin in three Trypoxylon species. The heterochromatin was GC-rich in all the species studied; however, in Trypoxylon nitidum F. Smith, 1856the molecular composition of the heterochromatinwasdifferent among chromosome pairs. Conversely, the euchromatin was AT-rich in the three species. These results suggest high conservatism in the euchromatic regions as opposed to the heterochromatic regions that have a high rate of changes. In this study, we report the karyotype of Trypoxylon rugifrons F. Smith, 1873which has the lowest chromosome number in the genus and other characteristics of the likely ancestral Trypoxylon karyotype.

  5. Experimental analysis of singularity-avoidance techniques for CMA equalization in DP-QPSK 112-Gb/s optical systems.

    PubMed

    Rozental, Valery N; Portela, Thiago F; Souto, Diego V; Ferreira, Hugo B; Mello, Darli A A

    2011-09-12

    We experimentally investigate the singularity problem in DP-QPSK 112-Gb/s receivers using the CMA. Three algorithms are compared: Constrained, Two-Stage, and Multi-User. Although these algorithms have been individually evaluated, they have not been compared by extensive experiments. The transmission setup emulates amplifier noise; first-order PMD; and chromatic dispersion. It is shown that all algorithms effectively mitigate singularities. However, under certain conditions, the Multi-User and the Constrained algorithms--both used for system startup--outperformed the Two-Stage, which does not distinguish between system operation and startup. In light of its effectiveness and low computational complexity, we recommend the Constrained algorithm.

  6. Comparison of CMA joint statement on resuscitative interventions and New Brunswick hospital corporations' policies on end-of-life treatments.

    PubMed

    Poirier, N

    2000-01-01

    Why do most physicians have so much difficulty respecting the wishes of their terminally ill patients who refuse treatment? The normative pluralism model is introduced to answer this question. Comparative content analysis serves as the theoretical framework for evaluating the Canadian Medical Association Joint Statement on Resuscitative Interventions against the corresponding administrative policies of New Brunswick hospital corporations and relevant New Brunswick law. Despite protection afforded patients by law, fully 75% of New Brunswick hospital corporations' administrative policies permit physicians to ignore patients' expressed objection to treatments. The futility-of-treatment criteria in the CMA joint statement and in all provincial hospital corporations' policies authorize physicians to substitute their judgment for patients' expressed refusal of CPR. The author concludes that when medical professional norms conflict with the law, physicians tend to follow their professional normative order.

  7. Pediatric Headaches.

    PubMed

    Slover, Robin; Kent, Sheryl

    2015-08-01

    Pediatric headaches are common, and many may never require intervention by a health care provider. However, migraines can become more difficult to treat, especially if they become chronic daily headaches. Pediatric headache is a subjective and unique experience that requires attention to both psychological and physiologic components in diagnosis and treatment. A biopsychosocial, multidisciplinary approach, including both medication management and psychological treatment, is considered essential for effective management.

  8. Pediatric Anthropometry

    NASA Astrophysics Data System (ADS)

    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.

  9. Pediatric melanoma.

    PubMed

    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.

  10. Pediatric headache.

    PubMed

    Winner, Paul

    2008-06-01

    Headaches occur frequently in the pediatric population and have a significant impact on both the patient and their family. Migraine, the most common headache disorder for which patients see a physician, still remains underdiagnosed and undertreated. Recent studies have revealed the increasing incidence of migraine and chronic migraine in the pediatric population. Limitations of the present diagnostic criteria for migraine are presented, and the proposed modifications to these criteria may assist you with early recognition and ultimate treatment. New acute and preventive migraine treatment data demonstrating statistically significant benefit for the primary endpoints will be reviewed in detail. The clinically relevant impact of migraine on the pediatric patient documented by the use of the Pediatric Migraine Disability Assessment and the Pediatric Quality of Life Inventory will be discussed. A comprehensive management approach blending the most current acute, preventive, and biobehavioral treatments will be reviewed. Further research, with novel study designs, in pediatric headaches is needed to help reveal additional pathophysiological mechanisms, improve diagnostic criteria, and advance optimal treatment. Prospective studies are needed to fully evaluate the efficacy of preventive management in this population and to establish whether early intervention might slow this disease progression.

  11. Pediatric nurses' attitudes toward hospice and pediatric palliative care.

    PubMed

    Knapp, Caprice A; Madden, Vanessa; Wang, Hua; Kassing, Kristin; Curtis, Charlotte; Sloyer, Phyllis; Shenkman, Elizabeth A

    2011-01-01

    Several studies have investigated nurses' attitudes toward hospice and palliative care for adults, yet little information exists about pediatrics. Assessing pediatric nurses' attitudes is especially important in Florida, where a publicly funded pediatric palliative care program operates in eight cities across the State. The aims of this study were 1) to assess the attitudes toward hospice and palliative care, and 2) to examine the associations between sociodemographic and nursing care factors and nurses' attitudes toward hospice and palliative care. A cross-sectional research design using online and mail-in survey data was used to address the study aims. Surveys were conducted with 279 pediatric nurses across Florida. Bivariate results showed there were significant differences between the attitudes of pediatric nurses employed in a city with a pediatric palliative care program versus those not employed in a program site (p = 0.05). Multivariate analyses also showed that being employed in a program site increased attitudinal scores toward hospice and pediatric palliative care by 0.6 points. Beyond being employed in an area city where a pediatric palliative care program operates, results also suggest that having prior training in palliative care could alter nurses' attitudes, which might subsequently lead to increased referrals and improved outcomes for children and families.

  12. Show Code.

    PubMed

    Shalev, Daniel

    2017-01-01

    "Let's get one thing straight: there is no such thing as a show code," my attending asserted, pausing for effect. "You either try to resuscitate, or you don't. None of this halfway junk." He spoke so loudly that the two off-service consultants huddled at computers at the end of the unit looked up… We did four rounds of compressions and pushed epinephrine twice. It was not a long code. We did good, strong compressions and coded this man in earnest until the end. Toward the final round, though, as I stepped up to do compressions, my attending looked at me in a deep way. It was a look in between willing me as some object under his command and revealing to me everything that lay within his brash, confident surface but could not be spoken. © 2017 The Hastings Center.

  13. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. First quarterly project status report, 1 October 1992--31 December 1992

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.

    1992-12-31

    The principal objectives of the proposed research are two-fold: (A) To understand the mechanism and assess the effectiveness of sulfur capture by the chemical calcium magnesium acetate (CMA). And (B) To evaluate the NO{sub x} reduction capabilities of CMA by burning the organic constituents of the chemical (the acetate) and reducing NO to stable N{sub 2} The optimum conditions and the location of CMA introduction in the furnace will be identified. To achieve these goals water solutions of CMA or dry powders of CMA will be injected into hot air or gases simulating the furnace exhaust (containing CO{sub 2}, SO{sub x} NO{sub x}, H{sub 2}O, O{sub 2} etc.) and the composition of gaseous and solid products of the reaction will be monitored. The processes of burning the organic acetate as well as the calcination, sintering and sulfation of the remaining solid will be studied in detail.

  14. A Search for X-Ray Evidence of a Compact Companion to the Unusual Wolf-Rayet Star HD 50896 (EZ CMa)

    NASA Technical Reports Server (NTRS)

    Skinner, Stephen L.; Itoh, Masayuki; Nagase, Fumiaki

    1998-01-01

    We analyze results of a approx.25 ksec ASCA X-ray observation of the unusual Wolf-Rayet star HD 50896 (= EZ CMa). This WN5 star shows optical and ultraviolet variability at a 3.766 day period, which has been interpreted as a possible signature of a compact companion. Our objective was to search for evidence of hard X-rays (greater than or equal to 5 keV) which could be present if the WN5 wind is accreting onto a compact object. The ASCA spectra are dominated by emission below 5 keV and show no significant emission in the harder 5-10 keV range. Weak emission lines are present, and the X-rays arise in an optically thin plasma which spans a range of temperatures from less than or equal to 0.4 keV up to at least approx. 2 keV. Excess X-ray absorption above the interstellar value is present, but the column density is no larger than N(sub H) approx. 10(exp 22)/sq cm. The absorption-corrected X-ray luminosity L(sub x)(0.5 - 10 keV) = 10(exp 32.85) erg/s gives L(sub x)/ L(sub bol) approx. 10(exp -6), a value that is typical of WN stars. No X-ray variability was detected. Our main conclusion is that the X-ray properties of HD 50896 are inconsistent with the behavior expected for wind accretion onto a neutron star or black hole companion. Alternative models based on wind shocks can explain most aspects of the X-ray behavior, and we argue that the hotter plasma near approx. 2 keV could be due to the WR wind shocking onto a normal (nondegenerate) companion.

  15. Controversies in Pediatric Perioperative Airways.

    PubMed

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.

  16. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  17. Pediatric dermatology.

    PubMed

    Baruch, K

    1986-07-01

    Dr. Baruch presents some of the most common pediatric lower extremity skin conditions seen in clinical practice. The conditions that he discusses appear to be relatively easy to diagnose in the early stages; however, some of them, such as contact dermatitis and atopic dermatitis, may be hard to distinguish from one another. I have to admit that I have never seen lichen planus in the pediatric age group; I will need to keep looking. I agree with Dr. Baruch that classification of lesions into either the primary and secondary groups will aid in diagnosis and treatment. It also seems that the ever-present verrucae is the most common pediatric condition seen in our office, and we have taken similar steps in treating this condition with blunt dissection with excellent results.

  18. Pediatric photosensitivity.

    PubMed

    Grossberg, Anna L

    2012-08-01

    Photosensitivity is a rarely encountered problem in the pediatric population. It may be caused by a diverse group of primary, idiopathic photosensitivity conditions, or may reflect photoexacerbation of an existing dermatosis. In addition, there are several genodermatoses, metabolic disorders, and connective tissue disorders that can present with photosensitivity, usually in addition to other extracutaneous clinical and laboratory findings. It is important that both dermatologic and pediatric practitioners be able to recognize the various causes of photosensitivity, as well as be familiar with the associated stigmata and necessary workup, if needed, of each particular disorder. This review offers an approach to the pediatric patient who presents with photosensitivity, with emphasis on arriving at the proper diagnosis, necessary evaluations, and management strategies. © 2012 John Wiley & Sons A/S.

  19. Cow's milk allergy related pediatric constipation: appropriate time of milk tolerance.

    PubMed

    El-Hodhod, M A; Younis, N T; Zaitoun, Y A; Daoud, S D

    2010-03-01

    Cow's milk allergy (CMA) has different clinical presentations according to age. The study aimed to evaluate the extent of CMA as a cause of pediatric constipation and determine the appropriate timing of tolerance to cow milk in such patients. The study included 60 patients suffering from chronic functional constipation, 27 of whom did not respond to 2 month laxative therapy (group I). Thirty age and sex matched apparently healthy infants and children were studied as a control group (group II). Serum specific IgE to cow milk proteins was measured. Withdrawal of cow milk and dairy products for a 1 month period was then followed by cow milk re-challenge over 2 wk. Patients were classified into: responders to this schedule (cow milk allergic=group Ia; n=21) and non-responders (non-cow milk allergic=group Ib; n=6). Eighteen CMA patients continued the study where nine of them underwent milk reinstitution after 6 months and another nine patients after 12 months of elimination. The frequency of CMA among constipated patients was 77.7%. Mean values of serum specific IgE to whole cow milk protein and beta-lactoglobulins were significantly higher in constipated patients (0.82+/-0.08, 0.79+/-0.13 IU/ml, respectively) compared with controls (0.26+/-0.14, 0.27+/-0.14 IU/ml, respectively) and in group Ia (0.99+/-0.08, 0.95+/-0.14 IU/ml, respectively) compared with group Ib (0.39+/-0.06, 0.37+/-0.10 IU/ml, respectively). Serum specific IgE was positive in 85.7% of CMA group, predominantly in class 2. Tolerance to cow milk was achieved after 6 months in only 22.2% compared with 88.8% after 12 months of elimination. In conclusion, CMA is shown to be a significant etiologic factor for constipation in infants and young children. Serum levels of IgE to cow milk proteins are helpful although not definitive for diagnosis. Based on this limited study, tolerance is better achieved after 12 months of strict cow's milk elimination.

  20. Pediatric Sarcomas.

    PubMed

    Williams, Regan F; Fernandez-Pineda, Israel; Gosain, Ankush

    2016-10-01

    Pediatric sarcomas are a heterogeneous group of tumors accounting for approximately 10% of childhood solid tumors. Treatment is focused on multimodality therapy, which has improved the prognosis over the past two decades. Current regimens focus on decreasing treatment for low-risk patients to decrease the long-term side effects while maximizing therapy for patients with metastatic disease to improve survival. Pediatric sarcomas can be divided into soft tissue sarcomas and osseous tumors. Soft tissue sarcomas are further delineated into rhabdomyosarcomas, which affect young children and nonrhabdomyosarcomas, which are most common in adolescents. The most common bone sarcomas are osteosarcomas and Ewing's sarcoma.

  1. Pediatric rosacea.

    PubMed

    Kellen, Roselyn; Silverberg, Nanette B

    2016-07-01

    Because rosacea is uncommon in the pediatric population, care must be taken to exclude other papulopustular disorders. Children can present with vascular, papulopustular, and/or ocular findings. Importantly, ocular symptoms can appear before the cutaneous symptoms of rosacea, leading to misdiagnosis. Rosacea is a clinical diagnosis, but histopathologic examination typically reveals dilated vessels, perivascular lymphohistiocytic infiltrates in the upper dermis, elastosis, and disorganization of the upper dermal connective tissue. Treatment involves avoiding known triggers and utilizing topical and/or systemic therapies. Although treatment can control flares, pediatric rosacea often persists into adulthood.

  2. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. [Third quarterly progress report], 1 July 1994--30 September 1994

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.; Steciak, J.

    1994-11-01

    The principal objectives of this research are two-fold: (A) To understand the mechanism and assess the effectiveness of sulfur capture by the chemical calcium magnesium acetate (CMA); and (B) To evaluate the NO{sub x} reduction capabilities of CMA by pyrolyzing the organic constituents of the chemical (the acetate) and reducing NO to stable N{sub 2}. The optimum conditions and the location of CMA introduction in the furnace will be identified. To achieve these goals water solutions of CMA or dry powders of CMA were injected into hot air or gases simulating the furnace exhaust (containing SO{sub x}, NO{sub x} H{sub 2}O, O{sub 2} etc.) and the composition of gaseous and solid products of the reaction was monitored. The processes of burning the organic acetate as well as the calcination, sintering and sulfation of the remaining solid are studied. The effectiveness of ``homemade`` CMAs containing various amounts of calcium and magnesium was investigated to explore the role of the two chemicals in the NO{sub x} and mainly the SO{sub 2} capture processes. Finally, CMA was introduced in the matrix of coal particles by an ion exchange technique. Upon subsequent combustion, the SO{sub 2}-NO{sub x} emissions were monitored and compared to those from burning untreated coal. The composition and physical structure of the ash residues was examined. Both techniques (CMA pretreatment and CMA injection) may commercially be implemented separate or simultaneously. The work reported herein pertains to introducing dry CMA and other carboxylic salts of calcium: calcium formate (CF), calcium acetate (CA), calcium propanate (CP) and calcium benzoate (CB) in the post-flame region of the furnace and monitoring the SO{sub 2} and NO{sub x}, emissions.

  3. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. Seventh quarterly project status report, April 1, 1994--June 30, 1994

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.

    1995-02-01

    The principal objectives of this research are two-fold: (A) To understand the mechanism and assess the effectiveness of sulfur capture by the chemical calcium magnesium acetate (CMA); and (B) To evaluate the NO{sub x} reduction capabilities of CMA by pyrolyzing the organic constituents of the chemical (the acetate) and reducing NO to stable N{sub 2}. The optimum conditions and the location of CMA introduction in the furnace will be identified. To achieve these goals water solutions of CMA or dry powders of CMA were injected into hot air or gases simulating the furnace exhaust (containing SO{sub x}, NO{sub x}, H{sub 2}O, O{sub 2} etc.) and the composition of gaseous and solid products of the reaction was monitored. The processes of burning the organic acetate as well as the calcination, sintering and sulfation of the remaining solid are studied. The effectiveness of {open_quotes}homemade{close_quotes} CMAs containing various amounts of calcium and magnesium was investigated to explore the role of the two chemicals in the NO{sub x} and mainly the SO{sub 2} capture processes. Finally, CMA was introduced in the matrix of coal particles by an ion exchange technique. Upon subsequent combustion, the SO{sub 2}-NO{sub x} emissions were monitored and compared to those from burning untreated coal. The composition and physical structure of the ash residues was examined. Both techniques (CMA pretreatment and CMA injection) may commercially be implemented separate or simultaneously. The work reported herein pertains to introducing dry or wet CMA in the post-flame region of the furnace and monitoring the SO{sub 2} and NO{sub x} emissions.

  4. Pediatric Dermatology

    PubMed Central

    McMahon, Patrick

    2017-01-01

    Skin changes are common in children. Common concerns are birthmarks (e.g., hemangiomas and port wine stains), atopic and contact dermatitis, acne, and alopecia areata. The authors review advances in common and not so common skin changes in pediatric patients. PMID:28360970

  5. Pediatric vasculitis.

    PubMed

    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.

  6. Analysis of the V-Band Light Curve of the Be Star ω CMa with the Viscous Decretion Disk Model

    NASA Astrophysics Data System (ADS)

    Ghoreyshi, M. R.; Carciofi, A. C.

    2017-02-01

    We analyze the V-band photometry data of the Be star ω CMa, observed over the last four decades. The data is fitted by hydrodynamic models based on the viscous decretion disk (VDD) theory, in which a disk around a fast-spinning Be star is formed by material ejected by the central star and driven to progressively wider orbits by means of viscous torques. For the first time, we apply the model for both the disk build up and the dissipation phases. Our simulations offer a good description of the photometric variability in both phases, which suggests that the VDD model adequately describes the disk structural evolution. Furthermore, our analysis allowed us to determine the viscosity parameter (α) of the gas, as well as the net mass loss rate. We find that α is variable, ranging from 0.1 to 1.0, and that buildup phases have larger values of α than the dissipation phases. Additionally, we find that, contrary to what is generally assumed, even during quiescence the outward mass flux is never zero, suggesting that the star alternates between a high mass loss phase (outburst) and a low mass loss phase (quiescence).

  7. Pediatric sleep apnea

    MedlinePlus

    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 ...

  8. Pediatric tracheostomy.

    PubMed

    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.

  9. Pediatric parasomnias.

    PubMed

    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.

  10. Pediatric stridor.

    PubMed

    Ida, Jonathan B; Thompson, Dana Mara

    2014-10-01

    Pediatric stridor is an important symptom of upper airway obstruction, and must be recognized early by evaluating physicians. Proper evaluation and management, both acutely and chronically, can provide improved outcomes and better quality of life for patients. This article discusses the physiology of stridor and its intimate relation to airway anatomy, the work-up of the stridorous child, and recent advances in treatment, and provides illustrative examples of common lesions.

  11. Pediatric Virology

    PubMed Central

    Portnoy, Bernard

    1965-01-01

    Pediatric virology is not an isolàted discipline. Rather, the syndromes associated with viral infection are modified by the unique characteristics of infancy and childhood. Fortunately for the pediatrician, and certainly for children, viral infections in childhood are rarely fatal, and are almost never serious. Future efforts of the pediatrician and virologist should be directed toward increased fetal salvage as with rubella and the prevention of severe, viral lower respiratory tract disease. PMID:14298871

  12. Pediatric sialendoscopy.

    PubMed

    Bruch, Jean M; Setlur, Jennifer

    2012-01-01

    Sialendoscopy was introduced in the early 1990s as a minimally invasive alternative to standard methods for diagnosis and treatment of inflammatory and obstructive salivary gland disease. The technique was pioneered in adults; however, advances in instrumentation have allowed this to be adapted to the smaller salivary ductal anatomy found in the pediatric population. In this chapter, the technique of sialendoscopy for parotid and submandibular glands is described.

  13. Efficacy of an oral contraceptive containing EE 0.03 mg and CMA 2 mg (Belara) in moderate acne resolution: a randomized, double-blind, placebo-controlled Phase III trial.

    PubMed

    Plewig, Gerd; Cunliffe, William J; Binder, Natascha; Höschen, Kornelia

    2009-07-01

    The study was conducted to assess the effects of the monophasic combined oral contraceptive containing ethinyl estradiol (EE) 0.03 mg and chlormadinone acetate (CMA) 2 mg (EE/CMA) on papulopustular acne of the face, décolleté (low neck) and back; on moderate comedonal acne of the face; and on seborrhea, alopecia and hirsutism. Three hundred seventy-seven women were randomized (2:1) to receive EE/CMA (n=251) or placebo (n=126) for six medication cycles. Due to the placebo-controlled, double-blind design of the trial, condoms were supplied for contraception. The primary efficacy end point was defined as a reduction of at least 50% in the number of papules and/or pustules of the face from admission to Medication Cycle 6. In total, 64.1% (161/251) of subjects treated with EE/CMA responded compared with 43.7% (55/126) of those taking placebo (p=.0001). The median reduction in papules/pustules on the face at Cycle 6 compared with admission was 63.6% (EE/CMA) compared with 45.3% (placebo group). For comedonal lesions of the face, the reduction in lesion numbers was 54.8% (EE/CMA) compared with 32.4% (placebo). Moderate papulopustular acne of the décolleté decreased by 92.9% (EE/CMA) vs. 50% (placebo group) and of the back by 86.0% and 58.3%, respectively. For these skin conditions, the p values for the relative difference between groups vs. baseline were <.05 at Cycles 3 and 6, in favor of EE/CMA. As part of a self-assessment rating, at least 70.5% (EE/CMA) vs. 41.3% (placebo) reported an at least satisfactory improvement of their moderate acne. Even 39.8% of women taking EE/CMA reported an "excellent improvement" or "complete resolution" of moderate acne compared with 12.7% taking placebo. In addition to its contraceptive efficacy described elsewhere, EE/CMA is an effective treatment for moderate papulopustular acne and other androgen-related skin disorders.

  14. History of German pediatric cardiology.

    PubMed

    Heintzen, P

    2002-01-01

    Due to the isolation of German medicine in World War II accompanied by the destruction of many hospitals, German pediatricians did not show any serious interest in the treatment of children with congenital heart diseases, nor did they take notice of the progress achieved by Helen Taussig, Alfred Blalock and other cardiologists and surgeons in the western world. This problem was even worse in East Germany. Only a few German internists and forward-looking surgeons were able and ready to take care of this group of principally operable children in places like Bonn/Düsseldorf, Marburg/Munich, Berlin, and Hamburg. However, in the early 1950s some directors of pediatrics at university hospitals--largely motivated by the cardiac surgeons--allowed or even encouraged younger colleagues to concentrate on pediatric cardiology and to begin application of heart catheterization and angiocardiography. In 1960 a group of colleagues interested in pediatric cardiology met for the first time in Frankfurt and became the nucleus of the future "working group" (1969) and finally the "German Society of Pediatric Cardiology" (1974). By 1972 pediatric cardiology had been approved as an independent (sub)specialty. Colleagues and friends from surrounding countries (Austria, Great Britain, Sweden, Switzerland, and the Netherlands) and also from the US and some eastern countries were either members or regular guests during or between the meetings. Pediatric cardiology is now represented in Germany by specialized practitioners, trainees and assistants who work in both community and university hospitals, and in specialized departments. Due to the foresightedness of the Chief of Pediatrics, Prof. G. Joppich, the first Chair of Pediatric Cardiology was founded in Göttingen in 1960 under the direction of A. Beuren. Another model of interdisciplinary cooperation between pediatric cardiologists, bioengineers, mathematicians and computer scientists was established in Kiel in 1966. In other places

  15. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. Second quarterly project status report, 1 April 1993--30 June 1993

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.

    1993-09-01

    Objectives of the proposed research are two-fold: (A) To understand the mechanism and assess the effectiveness of sulfur capture by the chemical calcium magnesium acetate (CMA); and (B) To evaluate the NO{sub x} reduction capabilities of CMA by pyrolyzing the organic constituents of the chemical (the acetate) and reducing NO to stable N{sub 2}. The optimum conditions and the location of CMA introduction in the furnace will be identified. Water solutions of CMA or dry powders of CMA will be injected into hot air or gases simulating the furnace exhaust (containing CO{sub 2}, SO{sub x} NO{sub x} H{sub 2}O, O{sub 2} etc.) and the composition of gaseous and solid products of the reaction will be monitored. The processes of burning the organic acetate as well as the calcination, sintering and sulfation of the remaining solid will be studied. The effectiveness of ``homemade`` CMAs containing various amounts of calcium and magnesium will be investigated to explore the role of the two chemicals in the NO{sub x} and mainly the SO{sub 2} capture processes. CMA will be introduced in the matrix of coal particles by an ion exchange technique. Upon subsequent combustion, the SO{sub 2}-NO{sub x} emissions will be monitored and compared to those from burning untreated coal. The composition and physical structure of the ash residues will also be examined.

  16. Identification of LAG3 high affinity aptamers by HT-SELEX and Conserved Motif Accumulation (CMA).

    PubMed

    Soldevilla, Mario Martínez; Hervas, Sandra; Villanueva, Helena; Lozano, Teresa; Rabal, Obdulia; Oyarzabal, Julen; Lasarte, Juan José; Bendandi, Maurizio; Inoges, Susana; López-Díaz de Cerio, Ascensión; Pastor, Fernando

    2017-01-01

    LAG3 receptor belongs to a family of immune-checkpoints expressed in T lymphocytes and other cells of the immune system. It plays an important role as a rheostat of the immune response. Focus on this receptor as a potential therapeutic target in cancer immunotherapy has been underscored after the success of other immune-checkpoint blockade strategies in clinical trials. LAG3 showcases the interest in the field of autoimmunity as several studies show that LAG3-targeting antibodies can also be used for the treatment of autoimmune diseases. In this work we describe the identification of a high-affinity LAG3 aptamer by High Throughput Sequencing SELEX in combination with a study of potential conserved binding modes according to sequence conservation by using 2D-structure prediction and 3D-RNA modeling using Rosetta. The aptamer with the highest accumulation of these conserved sequence motifs displays the highest affinity to LAG3 recombinant soluble proteins and binds to LAG3-expressing lymphocytes. The aptamer described herein has the potential to be used as a therapeutic agent, as it enhances the threshold of T-cell activation. Nonetheless, in future applications, it could also be engineered for treatment of autoimmune diseases by target depletion of LAG3-effector T lymphocytes.

  17. Short-Term Spectral Variability in the Binary FS CMa-Type Object MWC 728

    NASA Astrophysics Data System (ADS)

    Zharikov, S. V.; Miroshnichenko, A. S.

    2017-02-01

    We report the results of a long-term spectroscopic monitoring of the FS CM-type object MWC 728. We found that it is a binary system with a B5 ve (T1,eff = 14000±1000 K) primary and a G8 III (T2,eff ˜ 5000 K) secondary. Absorption lines of the cool star show regular variations with a semi-amplitude of ˜20 km s-1 and a period of 27.5 days. The system mass function is 2.3×10-2 M⊙, and its orbital plane is ˜ 13-15° tilted from the plane of the sky. The hot star has a projected rotational velocity of ˜110 km s-1 which implies a nearly breakup rotation at the equator. We detected strong variations of the Balmer and He I emission-line profiles on timescales from days to years. This points out to a variable stellar wind of the hot star in addition to the presence of a circum-primary gaseous disk. The strength of the absorption-line spectrum along with the optical and near-IR continuum suggest that the hot star contributes ˜60% of the V-band flux, the disk contributes ˜30%, and the cool star ˜10%.The binary system parameters, along with the interstellar extinction, suggest a distance of ˜1 kpc, that the cool star radius (˜8 R⊙) is smaller than its Roche lobe, and that the companions' mass ratio is q ˜0.5. Overall, the observed spectral variability and the presence of a strong IR-excess are in agreement with a model of a close binary system that has undergone a non-conservative mass-transfer.

  18. Introduction to pediatric oncology

    SciTech Connect

    McWhirter, W.R.; Masel, J.P.

    1987-01-01

    This book covers the varied and complex aspects of management in pediatric oncology. Emphasis is placed on a team approach and on establishing and maintaining an individualized, humanistic relationships with the patient. Numerous illustrations show modern imaging techniques that are proving most valuable in the investigation of suspected or confirmed childhood cancer. Physical and psychological side effects of short-term and long-term treatment are also discussed.

  19. Pediatric nutrition.

    PubMed

    Greco, Deborah S

    2014-03-01

    This article discusses pediatric nutrition in puppies and kittens. Supplementation of basic nutrients such as fat, protein, minerals, vitamins, and essential fatty acids of the bitch is essential for the proper growth and development of puppies during the lactation period. Milk replacers are compared for use in puppies and kittens. Supplements such as colostrum and probiotics for promotion of a healthy immune system and prevention or treatment of stress-induced and weaning diarrhea are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Pediatric Appendicitis.

    PubMed

    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.

  1. Pediatric urticaria.

    PubMed

    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.

  2. Pediatric vitiligo.

    PubMed

    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.

  3. Pediatric vasculitis.

    PubMed

    Weiss, Pamela F

    2012-04-01

    Childhood vasculitis is a challenging and complex group of conditions that are multisystem in nature and often require integrated care from multiple subspecialties, including rheumatology, dermatology, cardiology, nephrology, neurology, and gastroenterology. Vasculitis is defined as the presence of inflammation in the blood vessel wall. The site of vessel involvement, size of the affected vessels, extent of vascular injury, and underlying pathology determine the disease phenotype and severity. This article explores the classification and general features of pediatric vasculitis, as well as the clinical presentation, diagnostic evaluation, and therapeutic options for the most common vasculitides.

  4. Dental traumatology: an orphan in pediatric dentistry?

    PubMed

    Andreasen, Jens Ove; Lauridsen, Eva; Daugaard-Jensen, Jette

    2009-01-01

    Traumatic dental injuries are very frequent during childhood and adolescence. In fact, 2 out of 3 children have suffered a traumatic dental injury before adulthood. This fact links dental traumatology to pediatric dentistry. Unfortunately, this is not reflected by active participation by pediatric dentists in acute treatment, follow-up, and research. To examine the status of pediatric dentistry in relation to dental trauma, a publication analysis was undertaken in 1980, 1990, 2000, and 2007 about trauma articles published in 4 pediatric journals: journal of Dentistry for Children, Pediatric Dentistry, The journal of Pedodontics, and the International journal of Pediatric Dentistry. This study shows an average publication rate of trauma articles of approximately 3 percent of all articles published and with no improvement in later decennia. If only clinical studies are considered (leaving out case reports), the publication rate is less than 1 percent--completely out of proportion to the size of the problem dental trauma impose in children.

  5. CMA abortion survey.

    PubMed Central

    1983-01-01

    Responses to the question as to whether abortions should be performed at the woman's request during the first trimester of pregnancy were evenly divided. There was support for abortion on socioeconomic grounds, during the first trimester, from 61.5% of the respondents. Termination of pregnancy beyond the first trimester was supported by a majority of the respondents only in cases in which the woman's life is in danger (73.9%) or in which there is evidence of a severe physical abnormality in the fetus (70.6%) or in cases in which the woman's physical health is in danger (55.5%). Those who said they would not support abortion under any circumstances constitute, at most, 5.1% of the respondents. Support for the maintenance or the elimination of therapeutic abortion committees was addressed in two questions and in both cases the respondents were evenly divided. The responses to these two questions were compared and found to be logically consistent. Only physicians should perform abortions, and they should be performed in hospitals with the woman either as an inpatient or, during the first trimester, as an outpatient. The performance of first-trimester abortions in provincially approved abortion clinics was supported by 47.3% of the respondents. Of the 885 respondents who wished to see some amendment to the Criminal Code, 409 stated that the term "health" as used in the Criminal Code relative to the legal grounds for therapeutic abortion should be defined. PMID:6861064

  6. Pediatric rhinitis risk factors

    PubMed Central

    Ji, Yaofeng; Liu, Yin; Yang, Na

    2016-01-01

    Rhinitis is a common global disorder that impacts on the quality of life of the sufferer and caregivers. Treatment for pediatric rhinitis is empirical and does not include a detailed history of the allergy triggers or allergy testing. Thus, allergen avoidance advice is not tailored to the child's sensitivities, which may result in adenoid hypertrophy. However, infant onset rhinitis, especially its relationship with respiratory viruses, remains to be further clarified. Rhinitis basically involves inflammation of the upper nasal lining, presenting typically with symptoms of runny nose (rhinorrhea), nasal blockage, and/or sneezing. While not typically fatal, it does impose significant health, psychological, and monetary burden to its sufferers, and is thus considered a global health problem. Previous findings showed that immunotherapy had significant clinical efficacy in children with allergic rhinitis. The present review article aims to highlight recent perspectives pertaining to the rhinitis risk factors especially in pediatric patients. PMID:27698737

  7. Pediatric Rhinosinusitis.

    PubMed

    Badr, Dana T; Gaffin, Jonathan M; Phipatanakul, Wanda

    2016-09-01

    Rhinosinusitis, is defined as an inflammation of the paranasal and nasal sinus mucosae. Chronic rhinosinusitis (CRS)is a common problem in the pediatric age group and the diagnosis and treatment are challenging due to the chronicity and similarity of symptoms with allergic rhinitis and adenoid hypertrophy. Although it is less common than acute rhinosinusitis, CRS is becoming more frequent and significantly affects the quality of life in children and can substantially impair daily function. CRS is characterized by sinus symptoms lasting more than 3 months despite medical therapy. Many factors are involved in the pathogenesis of this disease and include a primary insult with a virus followed bybacterial infection and mucosal inflammation, along with predisposition to allergies. The standard treatment of pediatricacute bacterial rhinosinusitis (ABRS) is nasal irrigation and antibiotic use. Medical treatment of pediatric CRS includes avoidance of allergens in allergic patients (environmental or food) and therapy with nasal irrigation, nasal corticosteroids sprays, nasal decongestants, and antibiotics directed at the most common sinonasalorganisms (Haemophilusinfluenzae, Streptococcus pneumoniae, and Moraxella catarrhalis). Surgical therapy is rarely needed after appropriate medical therapy. Referral to an otolaryngologist and allergy specialist is recommended in case of failure of medical treatment.

  8. The distribution of early-type stars in the Mon-CMa-Pup-Vel region of the Milky Way

    NASA Astrophysics Data System (ADS)

    Kaltcheva, N. T.

    precise mapping of the Mon-CMa-Pup-Vel field presented here provides the basis for a better understanding of how the massive stars dominate the structure and evolution of their environments.

  9. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. Sixth quarterly project status report, 1 January 1994--31 March 1994

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.; Steciak, J.; Simons, G.

    1994-06-01

    Conclusions: 1. Impregnation of pulverized coal particles by CMA and CA (and to leser extent MA) was found to increase the combustion temperature of both the volatile and the char phases. Effects of the additives on the burntime of either of the two phases could not be clearly detected. 2. The pretreatment of pulverized (75-90{mu}m) and micronized (3.5{mu}m mean) and beneficiated coals with CMA, CA or MA (at a Ca/S = 2) substantially reduced the emission of SO{sub 2}, at gas temperatures between 1250 to 1450 K, followed by a cool-down zone, in fuel-lean combustion ({phi} = 0.35-0.57). 3. The combustion of CMA-, CA-, or MA-treated pulverized coal in normal air suggested that all three sulfur caption mechanisms, mentioned in the introduction, were evident in the present experiments. 4. The results of experiments in normal air and in atmospheres containing 40% oxygen suggested that the release and subsequent sulfation of CaO and MgO aerosols may be the main mechanism for sulfur removal in the virtually ash-free micronized coal that was treated with CMA. 5. NO{sub x} emissions were increased with higher gas temperatures. Micronized coal produced 25% less NO{sub x} than pulverized coal. This could be due to its lower nitrogen content and slightly more fuel-rich conditions for the micronized coal combustion, as well as localized fuel-rich conditions surrounding the small particles as the volatiles and char burn together. 6. The emissions of NO{sub x} from CMA-treated pulverized coal were similar to those from untreated coal, whereas CMA-treated micronized coal released slightly more NO{sub x} than it did when untreated. The latter event may be caused by the added fuel oxygen associated with the effective penetration of the CMA additive.

  10. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. Fourth quarterly project status report, 1 July 1993--30 September 1993

    SciTech Connect

    Levendis, Y.A.; Wise, D.L.

    1993-12-01

    CMA, has demonstrated exceptional effectiveness in our laboratory as an in-boiler SO{sub 2} removal agent (Levendis, et al., 1993). This is due to the affinity of the calcium component of CMA for sulfur; the reaction results in solid sulfate salts. The current investigation explored the role of the organic component of CMA, as well as that in CA and CB, in removing the NO{sub x} emissions in the post-flame region of pulverized coal or residual oil-fired furnaces. This work was based on high-temperature laboratory-bench experiments under temperatures and oxygen concentrations similar to those found in commercial furnaces. The gas temperatures ranged from 450 to 1450{degrees}C and oxygen concentration varied from 0 to 5%. The residence time was in the order of 4 s. Injection of the CMA reagent at a mass ratio of CMA/NO of 41 (or an equivalent acetate/NO molar ratio of 17) reduced NO by more than 90% (at 0% O{sub 2} and temperatures above 850{degrees}C) to 50% (at 5% O{sub 2} and 650 to 850{degrees}C). At an oxygen concentration of 2%, NO reduction seemed to be most effective between 1000 and 1350{degrees}C with NO reductions of 70 to 80%. The efficacy of calcium acetate (CA) and calcium benzoate (CB) as NO{sub x} reducers was also explored, with CA (CA/NO mass ratio of 41 and acetate/NO molar ratio of 16) being less efficient than CMA with oxygen present but as efficient in 0% oxygen. CB (CB/NO mass ratio of 41 with benzoic acid/NO molar ratio of 9) was a-s efficient as CMA, regardless of O{sub 2} concentration, but at temperatures 300 to 450{degrees}C higher.

  11. Chromosome studies of Astyanax jacuhiensis Cope, 1894 (Characidae) from the Tramandai River Basin, Brazil, using in situ hybridization with the 18S rDNA probe, DAPI and CMA3 staining.

    PubMed

    da Silva, Laura Lahr Lourenço; Giuliano-Caetano, Lucia; Dias, Ana Lúcia

    2012-01-01

    The genus Astyanax comprises 86 species of fish distributed in Brazilian river basins and is considered of the Incertae sedis group within the family Characidae. This study presents an analysis of 12 specimens of Astyanax jacuhiensis from the Tramandai River Basin, RS Brazil: 6 from the Maquiné River and 6 from the Quadros Lagoon. All specimens showed a diploid number equal to 50 chromosomes with different karyotypic formula between the two localities. The population from the Maquiné River showed 10m+26sm+6st+8a (FN=92). Fish from the Quadros Lagoon showed 12m+20sm+6st+12a (FN=88). AgNORs were evidenced in the short arm of one acrocentric chromosome pair in both populations, confirmed by FISH with the 18S rDNA probe. CMA3 fluorochrome corresponded with the AgNOR sites, while DAPI staining was negative in these regions. C banding revealed that heterochromatin was weakly distributed, mainly in the pericentromeric and terminal regions in most chromosomes. Analyses of male gonadal tissue were conducted with the objective of characterizing the meiotic chromosome behavior in A. jacuhiensis. The following stages were evidenced: spermatogonial with 50 chromosomes, pachytene and metaphase I with 25 bivalents, and metaphase II with 25 chromosomes, thus confirming the diploid number of the species. Chromosomal abnormalities were not observed. This study shows preliminary data on A. jacuhiensis from the Tramandai River Basin, contributing with more chromosomal information for this group of fish.

  12. SEARCHING FOR COOL DUST IN THE MID-TO-FAR INFRARED: THE MASS-LOSS HISTORIES OF THE HYPERGIANTS μ Cep, VY CMa, IRC+10420, AND ρ Cas

    SciTech Connect

    Shenoy, Dinesh; Humphreys, Roberta M.; Jones, Terry J.; Gehrz, Robert D.; Marengo, Massimo; Helton, L. Andrew; Hoffmann, William F.; Skemer, Andrew J.; Hinz, Philip M.

    2016-03-15

    We present mid- and far-IR imaging of four famous hypergiant stars: the red supergiants μ Cep and VY CMa, and the warm hypergiants IRC +10420 and ρ Cas. Our 11–37 μm SOFIA/FORCAST imaging probes cool dust not detected in visual and near-IR imaging studies. Adaptive optics 8–12 μm imaging of μ Cep and IRC +10420 with MMT/MIRAC reveals extended envelopes that are the likely sources of these stars’ strong silicate emission features. We find μ Cep’s mass-loss rate to have declined by about a factor of five over a 13,000 year history, ranging from 5 × 10{sup −6} down to ∼1× 10{sup −6} M{sub ⊙} yr{sup −1}. The morphology of VY CMa indicates a cooler dust component coincident with the highly asymmetric reflection nebulae seen in the visual and near-IR. The lack of cold dust at greater distances around VY CMa indicates that its mass-loss history is limited to the last ∼1200 years, with an average rate of 6 × 10{sup −4} M{sub ⊙} yr{sup −1}. We find two distinct periods in the mass-loss history of IRC +10420 with a high rate of 2 × 10{sup −3} M{sub ⊙} yr{sup −1} until approximately 2000 years ago, followed by an order of magnitude decrease in the recent past. We interpret this change as evidence of its evolution beyond the RSG stage. Our new infrared photometry of ρ Cas is consistent with emission from the expanding dust shell ejected in its 1946 eruption, with no evidence of newer dust formation from its more recent events.

  13. Cytogenetic analysis of Otiorhynchus bisulcatus (Fabricius, 1781) and O.(Zadrehus) atroapterus (De Geer, 1775) (Coleoptera, Curculionidae, Entiminae) using C bands, NORs, and DAPI/CMA3 staining.

    PubMed

    Holecová, Milada; Maryańska-Nadachowska, Anna; Rozek, Maria

    2013-01-01

    The structure of the karyotypes of two Otiorhynchus species belonging to separate subgenera, viz. Otiorhynchus s.str. bisulcatus and O. (Zadrehus) atroapterus, is compared and described for the first time. Both species have the same chromosome number (2n = 22), sex chromosome system of an achiasmate parachute type (Xy(p)), symmetric karyotype with the prevalence of metacentrics, similar meiotic behaviour, localization of NORs and positive DAPI signals. The main differences involve the morphology of autosomes and the X chromosome in the C-banding pattern and DAPI/CMA3 signals as well as in the presence of additional B chromosomes.

  14. Euthanasia—An Overview for Our Time A Report by the CMA Committee for Continuing Study of Evolving Trends in Society Affecting Life

    PubMed Central

    1973-01-01

    The Committee for the Continuing Study of Evolving Trends in Society Affecting Life was established by the CMA House of Delegates in 1971, following the consideration of a number of resolutions on the topic of abortion. The committee's charge was broadened, however, to include topics such as euthansia, biomedical engineering, medicine and religion, ecology and education. The committee's discussions, as its name indicates can cover a wide range of fields of interest to the medical profession. The following article is the first of several which the committee plans to publish, although the products of its deliberations may take the form of resolutions to future meetings of the House of Delegates. PMID:4694710

  15. Absolute ultraviolet spectrophotometry of: alpha CMa, gamma Ori, kappa Ori, and alpha Leo; and a continuing calibration program and some preliminary results

    NASA Technical Reports Server (NTRS)

    Evans, D. C.

    1971-01-01

    Spectral observations of the stars alpha CMa, gamma Ori, kappa Ori, and alpha Leo have been obtained in the range 1150 to 4000 Angstroms, using rocket borne spectrometers. The payloads have a 13-inch diameter telescope, a rotatable concave diffraction grating, and three pulse counting photomultiplier photometers. The laboratory standards used as photometric references derive their primary calibration directly or indirectly from the National Bureau of Standards. An error range of up to + or - 10 percent is attributed to these laboratory standards; + or - 8 percent to the calibration procedure; and + or - 10 percent is assigned as an accidental error range.

  16. Pediatric tracheomalacia.

    PubMed

    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.

  17. How Do US Pediatric Residency Programs Teach and Evaluate Community Pediatrics and Advocacy Training?

    PubMed

    Lichtenstein, Cara; Hoffman, Benjamin D; Moon, Rachel Y

    2017-07-01

    In 2013, the Accreditation Council for Graduate Medical Education updated requirements for training in community pediatrics and advocacy in pediatric residency programs. In light of this update, the aim of this study was to better understand how community pediatrics is being taught and evaluated in pediatric residency programs in the United States. Cross-sectional exploratory study using a Web-based survey of pediatric residency program directors in September 2014. Questions focused on teaching and evaluation of 10 community pediatrics competencies. Of 85 programs (43% response rate), 30% offered a separate training track and/or 6-block individualized curriculum in community pediatrics or advocacy. More than 75% required all residents to learn 7 of 10 competencies queried. Respondents in urban settings were more likely to teach care of special populations (P = .02) and public speaking (P < .01). Larger programs were more likely to teach (P = .04) and evaluate (P = .02) community-based research. Experiential learning and classroom-based didactics were the most frequent teaching methodologies. Many programs used multiple teaching methodologies for all competencies. Observation was the most frequent evaluation technique used; portfolio review and written reflection were also commonly reported. Our findings show a strong emphasis on community pediatrics and advocacy teaching among responding US pediatric residency programs. Although respondents reported a variety of teaching and evaluation methods, there were few statistically significant differences between programs. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  18. A Study of Hypergiant Mass Loss in the Near-To-Mid Infrared: VY CMa, IRC +10420, mu Cep and rho Cas

    NASA Astrophysics Data System (ADS)

    Shenoy, Dinesh Prabhakar

    2016-01-01

    Stars of initial mass greater than 9 M_sun become red supergiants (RSGs), a short-lived stage during which they experience mass-loss that strongly influences their post-RSG evolution and end state. The highest luminosity RSGs, referred to here as hypergiants, experience episodic mass-loss whose mechanism remains poorly understood and motivates observations to help constrain it. This thesis studies mass loss from hypergiant stars with near-to-mid infrared imaging over a range of angular scales. The recent mass-loss history of the extreme red supergiant VY Canis Majoris and the warm hypergiant star IRC +10420 are studied at the sub-arcsecond scale with adaptive optics imaging and imaging polarimetry from 1 - 5 micron using LMIRCam on the Large Binocular Telescope (LBT) and MMT-Pol at the MMT Observatory. The nebular features of VY CMa are found to be highly polarized at 1.3 and 3.1 micron, with optically thick scattering required to reproduce the observed surface brightness. The flux of VY CMa's peculiar ``Southwest Clump'' is demonstrated to be due almost entirely to optically thick scattering, with little thermal emission, and with a lower limit mass of 5E-03 M_sun in this single feature. The imaging polarimetry of IRC +10420 at 2.2 micron resolves nebular emission with intrinsic polarization of 30%, with a high surface brightness indicating optically thick scattering largely in the plane of the sky. Using the polarimetry to constrain the scattered light emission, it is shown that the nebula's the emission is mostly thermal with a color temperature well above that for typical astrophysical dust. To probe further into hypergiants' history of mass-loss, mid-IR imaging with MMT/ MIRAC and SOFIA/FORCAST is used to study VY CMa, IRC +10420 and two additional hypergiants: the RSG mu Cep and the warm hypergiant rho Cas. Using DUSTY 1-D radiative transfer models, mu Cep's mass-loss rate is found to have declined by about a factor of 5 over a 13,000 history, ranging from 5E

  19. Quality improvement in pediatric surgery.

    PubMed

    Cameron, Danielle B; Rangel, Shawn J

    2016-06-01

    The goal of this review is to provide updates on the evolution of conceptual definitions as they relate to quality in healthcare, existing measurement platforms for performance benchmarking in pediatric surgery, and available tools for quality improvement that are relevant to care of the pediatric surgical patient. The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric has continued to evolve, now providing risk-adjusted safety outcomes data to over 70 hospitals and broadening its scope of quality measurement to include resource utilization and value-based metrics. Increasing use of checklists and other team-based communication tools show potential for making surgical care safer for children, and thoughtful application of quality improvement methods such as Lean methodology, six-sigma and others are helping to improve efficiency and increase healthcare value. Finally, efforts to define minimal resource standards for pediatric surgical care holds promise to improve outcomes for neonates and other children with complex surgical needs. Over the past decade, significant progress has been made in our ability to measure, benchmark and improve quality in pediatric surgery. Future efforts will need to facilitate broader participation in benchmarking programs and knowledge-sharing collaboratives, and to develop multidisciplinary, 'disease-specific' longitudinal care models where quality measurement extends before and beyond the 'traditional' 30-day perioperative period.

  20. Pediatric MATCH Infographic

    Cancer.gov

    Infographic explaining NCI-COG Pediatric MATCH, a cancer treatment clinical trial for children and adolescents, from 1 to 21 years of age, that is testing the use of precision medicine for pediatric cancers.

  1. Pediatric Thyroid Cancer

    MedlinePlus

    ... Marketplace Find an ENT Doctor Near You Pediatric Thyroid Cancer Pediatric Thyroid Cancer Patient Health Information News media ... and neck issues, should be consulted. Types of thyroid cancer in children: Papillary : This form of thyroid cancer ...

  2. Pediatric diagnostic imaging

    SciTech Connect

    Gyll, C.; Blake, N.S.

    1986-01-01

    This book treats the practical problems of pediatric radiography and radiological procedures. Written jointly by a radiographer and a radiologist, it covers pediatric positioning and procedures. An extended chapter covers neonatal radiography and radiology.

  3. American Pediatric Surgical Association

    MedlinePlus

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  4. Nuances in pediatric trauma.

    PubMed

    Kenefake, Mary Ella; Swarm, Matthew; Walthall, Jennifer

    2013-08-01

    Pediatric trauma evaluation mimics adult stabilization in that it is best accomplished with a focused and systematic approach. Attention to developmental differences, anatomic and physiologic nuances, and patterns of injury equip emergency physicians to stabilize and manage pediatric injury.

  5. Pediatric Brain Tumor Foundation

    MedlinePlus

    ... you insights into your child's treatment. LEARN MORE Brain tumors and their treatment can be deadly so ... Pediatric Brain Tumor Foundation Board Read more >> Pediatric Brain Tumor Foundation 302 Ridgefield Court, Asheville, NC 28806 ...

  6. Nuclear imaging in pediatrics

    SciTech Connect

    Siddiqui, A.R.

    1985-01-01

    The author's intent is to familiarize practicing radiologists with the technical aspects and interpretation of nuclear medicine procedures in children and to illustrate the indications for nuclear medicine procedures in pediatric problems. Pediatric doses, dosimetry, sedation, and injection techniques, organ systems, oncology and infection, testicular scanning and nuclear crystography, pediatric endocrine and skeletal systems, ventilation and perfusion imaging of both congenital and acquired pediatric disorders, cardiovascular problems, gastrointestinal, hepatobiliary, reticuloendothelial studies, and central nervous system are all topics which are included and discussed.

  7. Pediatric electrocardiographic imaging applications.

    PubMed

    Silva, Jennifer N A

    2015-03-01

    Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: (1) ECGI in patients with congenital heart disease and Wolff–Parkinson–White syndrome, (2) ECGI in patients with hypertrophic cardiomyopathy and preexcitation, (3) ECGI in pediatric patients with Wolff–Parkinson–White syndrome, and (4) ECGI for pediatric cardiac resynchronization therapy.

  8. The 2008 outburst in the young stellar system Z CMa. III. Multi-epoch high-angular resolution images and spectra of the components in near-infrared

    NASA Astrophysics Data System (ADS)

    Bonnefoy, M.; Chauvin, G.; Dougados, C.; Kóspál, Á.; Benisty, M.; Duchêne, G.; Bouvier, J.; Garcia, P. J. V.; Whelan, E.; Antoniucci, S.; Podio, L.

    2017-01-01

    Context. Z CMa is a complex pre-main sequence binary with a current separation of 110 mas, known to consist of an FU Orionis star (SE component) and an embedded Herbig Be star (NW component). Although it represents a well-studied and characterized system, the origin of photometric variabilities, the component properties, and the physical configuration of the system remain mostly unknown. Aims: Immediately when the late-2008 outburst of Z CMa was announced to the community, we initiated a high angular resolution imaging campaign aimed at characterizing the outburst state of both components of the system in the near-infrared. Methods: We used the VLT/NACO and the Keck/NIRC2 near-infrared adaptive optics instrument to monitor the astrometric position and the near-infrared photometry of the Z CMa components during the outburst phase and one year after. The VLT/SINFONI and Keck/OSIRIS integral field spectroscrographs were in addition used to characterize for the first time the resolved spectral properties of the FU Orionis and the Herbig Be component during and after the outburst. Results: We confirm that the NW star dominates the system flux in the 1.1-3.8 μm range and is responsible for the photometric outburst. We extract the first medium-resolution (R 2000-4000) near-infrared (1.1-2.4 μm) spectra of the individual components. The SE component has a spectrum typical of FU Orionis objects. The NW component spectrum is characteristic of embedded outbursting protostars and EX Or objects. It displays numerous emission lines whose intensity correlates with the system activity. In particular, we find a correlation between the Brγ equivalent width and the system brightness. The bluing of the continuum of the NW component along with the absolute flux and color-variation of the system during the outburst suggests that the outburst was caused by a complex interplay between a variation of the extinction in the line of sight of the NW component on one hand, and the emission

  9. Searching for Cool Dust in the Mid-to-far Infrared: The Mass-loss Histories of the Hypergiants μ Cep, VY CMa, IRC+10420, and ρ Cas

    NASA Astrophysics Data System (ADS)

    Shenoy, Dinesh; Humphreys, Roberta M.; Jones, Terry J.; Marengo, Massimo; Gehrz, Robert D.; Helton, L. Andrew; Hoffmann, William F.; Skemer, Andrew J.; Hinz, Philip M.

    2016-03-01

    We present mid- and far-IR imaging of four famous hypergiant stars: the red supergiants μ Cep and VY CMa, and the warm hypergiants IRC +10420 and ρ Cas. Our 11-37 μm SOFIA/FORCAST imaging probes cool dust not detected in visual and near-IR imaging studies. Adaptive optics 8-12 μm imaging of μ Cep and IRC +10420 with MMT/MIRAC reveals extended envelopes that are the likely sources of these stars’ strong silicate emission features. We find μ Cep’s mass-loss rate to have declined by about a factor of five over a 13,000 year history, ranging from 5 × 10-6 down to ˜1× 10-6 M⊙ yr-1. The morphology of VY CMa indicates a cooler dust component coincident with the highly asymmetric reflection nebulae seen in the visual and near-IR. The lack of cold dust at greater distances around VY CMa indicates that its mass-loss history is limited to the last ˜1200 years, with an average rate of 6 × 10-4 M⊙ yr-1. We find two distinct periods in the mass-loss history of IRC +10420 with a high rate of 2 × 10-3 M⊙ yr-1 until approximately 2000 years ago, followed by an order of magnitude decrease in the recent past. We interpret this change as evidence of its evolution beyond the RSG stage. Our new infrared photometry of ρ Cas is consistent with emission from the expanding dust shell ejected in its 1946 eruption, with no evidence of newer dust formation from its more recent events. Based on observations obtained with: (1) the NASA/DLR Stratospheric Observatory for Infrared Astronomy (SOFIA). SOFIA is jointly operated by the Universities Space Research Association, Inc. (USRA), under NASA contract NAS2-97001, and the Deutsches SOFIA Institut (DSI) under DLR contract 50 OK 0901 to the University of Stuttgart; and (2) the MMT Observatory on Mt. Hopkins, AZ, a joint facility of the Smithsonian Institution and the University of Arizona.

  10. Pediatric lymphomas in Brazil

    PubMed Central

    Gualco, Gabriela; Klumb, Claudete E; Barber, Glen N; Weiss, Lawrence M; Bacchi, Carlos E

    2010-01-01

    OBJECTIVE: This study provides the clinical pathological characteristics of 1301 cases of pediatric/adolescent lymphomas in patients from different geographic regions of Brazil. METHODS: A retrospective analyses of diagnosed pediatric lymphoma cases in a 10‐year period was performed. We believe that it represents the largest series of pediatric lymphomas presented from Brazil. RESULTS: Non‐Hodgkin lymphomas represented 68% of the cases, including those of precursor (36%) and mature (64%) cell origin. Mature cell lymphomas comprised 81% of the B‐cell phenotype and 19% of the T‐cell phenotype. Hodgkin lymphomas represented 32% of all cases, including 87% of the classical type and 13% of nodular lymphocyte predominant type. The geographic distribution showed 38.4% of the cases in the Southeast region, 28.7% in the Northeast, 16.1% in the South, 8.8% in the North, and 8% in the Central‐west region. The distribution by age groups was 15–18 years old, 33%; 11–14 years old, 26%; 6–10 years old, 24%; and 6 years old or younger, 17%. Among mature B‐cell lymphomas, most of the cases were Burkitt lymphomas (65%), followed by diffuse large B‐cell lymphomas (24%). In the mature T‐cell group, anaplastic large cell lymphoma, ALK‐positive was the most prevalent (57%), followed by peripheral T‐cell lymphoma, then not otherwise specified (25%). In the group of classic Hodgkin lymphomas, the main histological subtype was nodular sclerosis (76%). Nodular lymphocyte predominance occurred more frequently than in other series. CONCLUSION: Some of the results found in this study may reflect the heterogeneous socioeconomical status and environmental factors of the Brazilian population in different regions. PMID:21340214

  11. Pediatric allergy and immunology in Spain.

    PubMed

    Nieto, Antonio; Mazon, Angel; Martin-Mateos, Maria Anunciacion; Plaza, Ana-Maria; Garde, Jesus; Alonso, Elena; Martorell, Antonio; Boquete, Manuel; Lorente, Felix; Ibero, Marcel; Bone, Javier; Pamies, Rafael; Garcia, Juan Miguel; Echeverria, Luis; Nevot, Santiago; Martinez-Cañavate, Ana; Fernandez-Benitez, Margarita; Garcia-Marcos, Luis

    2011-11-01

    The data of the ISAAC project in Spain show a prevalence of childhood asthma ranging from 7.1% to 15.3%, with regional differences; a higher prevalence, 22.6% to 35.8%, is described for rhinitis, and atopic dermatitis is found in 4.1% to 7.6% of children. The prevalence of food allergy is 3%. All children in Spain have the right to be visited in the National Health System. The medical care at the primary level is provided by pediatricians, who have obtained their titles through a 4-yr medical residency training program. The education on pediatric allergy during that period is not compulsory and thus very variable. There are currently 112 certified European pediatric allergists in Spain, who have obtained the accreditation of the European Union of Medical Specialist for proven skills and experience in pediatric allergy. Future specialists in pediatric allergy should obtain their titles through a specific education program to be developed in one of the four accredited training units on pediatric allergy, after obtaining the title on pediatrics. The Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) gathers over 350 pediatric allergists and pediatricians working in this field. SEICAP has a growing activity including yearly congresses, continued education courses, elaboration of technical clinical documents and protocols, education of patients, and collaboration with other scientific societies and associations of patients. The official journal of SEICAP is Allergologia et Immunophatologia, published every 2 months since 1972. The web site of SEICAP, http://www.seicap.es, open since 2004, offers information for professionals and extensive information on pediatric allergic and immunologic disorders for the lay public; the web site is receiving 750 daily visits during 2011. The pediatric allergy units are very active in clinical work, procedures as immunotherapy or induction of oral tolerance in food allergy, contribution to scientific literature, and

  12. A New Blind 2D-RAKE Receiver Based on CMA Criteria for Spread Spectrum Systems Suitable for Software Defined Radio Architecture

    NASA Astrophysics Data System (ADS)

    Takayama, Kei; Kamiya, Yukihiro; Fujii, Takeo; Suzuki, Yasuo

    Spread Spectrum (SS) has been widely used for various wireless systems such as cellular systems, wireless local area network (LAN) and so on. Using multiple antennas at the receiver, two-dimensional (2D) RAKE is realized over the time- and the space-domain. However, it should be noted that the 2D-RAKE receiver must detect the bit timing prior to the RAKE combining. In case of deep fading, it is often difficult to detect it due to low signal-to-noise power ratio (SNR). To solve this problem, we propose a new blind 2D-RAKE receiver based on the constant modulus algorithm (CMA). Since it does not need a priori bit timing detection, it is possible to compensate frequency selective fading even in very low SNR environments. The proposed method is particularly suitable for the software defined radio (SDR) architecture. The performance of the proposed method is investigated through computer simulations.

  13. Pediatric intensivist extenders in the pediatric ICU.

    PubMed

    Cramer, Cheryl L; Orlowski, James P; DeNicola, Lucian K

    2008-06-01

    This article explores the use of physician extenders in the pediatric ICU setting. The Libby Zion case is highlighted because of its impact on the use of manpower in the hospital setting. The history of physician extenders, including the hospitalist, physician assistant (PA), and nurse practitioner (NP), is discussed. Findings indicate a positive impact within the pediatric intensive care setting with the use of NPs and PAs. The American Academy of Pediatrics has supported the use of physician extenders in the care of hospitalized children.

  14. A study of the mutational landscape of pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma

    PubMed Central

    Ozawa, Michael G; Bhaduri, Aparna; Chisholm, Karen M; Baker, Steven A; Ma, Lisa; Zehnder, James L; Luna-Fineman, Sandra; Link, Michael P; Merker, Jason D; Arber, Daniel A; Ohgami, Robert S

    2016-01-01

    Pediatric-type follicular lymphoma and pediatric marginal zone lymphoma are two of the rarest B-cell lymphomas. These lymphomas occur predominantly in the pediatric population and show features distinct from their more common counterparts in adults: adult-type follicular lymphoma and adult-type nodal marginal zone lymphoma. Here we report a detailed whole-exome deep sequencing analysis of a cohort of pediatric-type follicular lymphomas and pediatric marginal zone lymphomas. This analysis revealed a recurrent somatic variant encoding p.Lys66Arg in the transcription factor interferon regulatory factor 8 (IRF8) in 3 of 6 cases (50%) of pediatric-type follicular lymphoma. This specific point mutation was not detected in pediatric marginal zone lymphoma or in adult-type follicular lymphoma. Additional somatic point mutations in pediatric-type follicular lymphoma were observed in genes involved in transcription, intracellular signaling, and cell proliferation. In pediatric marginal zone lymphoma, no recurrent mutation was identified; however, somatic point mutations were observed in genes involved in cellular adhesion, cytokine regulatory elements, and cellular proliferation. A somatic variant in AMOTL1, a recurrently mutated gene in splenic marginal zone lymphoma, was also identified in a case of pediatric marginal zone lymphoma. The overall non-synonymous mutational burden was low in both pediatric-type follicular lymphoma and pediatric marginal zone lymphoma (4.6 mutations per exome). Altogether, these findings support a distinctive genetic basis for pediatric-type follicular lymphoma and pediatric marginal zone lymphoma when compared with adult subtypes and to one another. Moreover, identification of a recurrent point mutation in IRF8 provides insight into a potential driver mutation in the pathogenesis of pediatric-type follicular lymphoma with implications for novel diagnostic or therapeutic strategies. PMID:27338637

  15. [Acquired immunodeficiency syndrome in pediatric patients].

    PubMed

    Molina Moguel, J L; Ruiz Illezcas, R; Forsbach Sánchez, S; Carreño Alvarez, S; Picco Díaz, I

    1990-12-01

    The object of this study was to determine how many of the patients treated at the Pediatric Odontology Clinic, a branch of the Maxillo-Facial Surgery Service at the Veinte de Noviembre Regional Hospital, ISSSTE, are VIH-positive of show serious manifestations of Acquired Immuno-Deficiency Syndrome (AIDS). For such purpose, 100 pediatric patients suffering from different systemic or local diseases were evaluated, the most common being hematological alterations. Results evidenced the presence of VIH in the blood of five of the pediatric subjects, all suffering from Hemophilia.

  16. Pseudomonas syringae pv. tomato DC3000 CmaL (PSPTO4723), a DUF1330 family member, is needed to produce L-allo-isoleucine, a precursor for the phytotoxin coronatine

    USDA-ARS?s Scientific Manuscript database

    Pseudomonas syringae pathovar tomato DC3000 produces the phytotoxin coronatine, a major determinant of the leaf chlorosis associated with DC3000 pathogenesis. The DC3000 PSPTO4723 (cmaL) gene is located in a genomic region encoding type III effectors, however it promotes chlorosis in the model plant...

  17. Antibody Therapy for Pediatric Leukemia

    PubMed Central

    Vedi, Aditi; Ziegler, David S.

    2014-01-01

    Despite increasing cure rates for pediatric leukemia, relapsed disease still carries a poor prognosis with significant morbidity and mortality. Novel targeted therapies are currently being investigated in an attempt to reduce adverse events and improve survival outcomes. Antibody therapies represent a form of targeted therapy that offers a new treatment paradigm. Monoclonal antibodies are active in pediatric acute lymphoblastic leukemia (ALL) and are currently in Phase III trials. Antibody-drug conjugates (ADCs) are the next generation of antibodies where a highly potent cytotoxic agent is bound to an antibody by a linker, resulting in selective targeting of leukemia cells. ADCs are currently being tested in clinical trials for pediatric acute myeloid leukemia and ALL. Bispecific T cell engager (BiTE) antibodies are a construct whereby each antibody contains two binding sites, with one designed to engage the patient’s own immune system and the other to target malignant cells. BiTE antibodies show great promise as a novel and effective therapy for childhood leukemia. This review will outline recent developments in targeted agents for pediatric leukemia including monoclonal antibodies, ADCs, and BiTE antibodies. PMID:24795859

  18. Age Limit of Pediatrics.

    PubMed

    Hardin, Amy Peykoff; Hackell, Jesse M

    2017-09-01

    Pediatrics is a multifaceted specialty that encompasses children's physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. The decision to continue care with a pediatrician or pediatric medical or surgical subspecialist should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet these needs. Copyright © 2017 by the American Academy of Pediatrics.

  19. What is Pediatric Palliative Care?

    MedlinePlus

    ... and Families Take the Quiz What Is Pediatric Palliative Care? Pediatric Palliative care (pronounced pal-lee-uh-tiv) is specialized ... for both the child and the family. Pediatric palliative care is provided by a team of doctors, ...

  20. What Is a Pediatric Gastroenterologist?

    MedlinePlus

    ... in adults. Specialized training and experience in pediatric gastroenterology are important. Pediatric gastroenterologists treat children from the ... training Three years of additional training in pediatric gastroenterology, hepatology, and nutrition, including medical research and treatment ...

  1. Pediatric Endocrinology Nurses Society

    MedlinePlus

    ... 2018! Wednesday, May 16, 2018 ​​​​​​​​​​​​​​​​​​​​​​​​​​​ Journal of Pediatric Nursing The Journal of Pediatric Nursing provides original, peer-reviewed research that is based on the philosophy that pediatric nursing incorporates a family-centered approach. PENS Executive Office • ...

  2. Laser gingivectomy for pediatrics.

    PubMed

    Kelman, Michelle M; Poiman, David J; Jacobson, Barry L

    2010-01-01

    Traditional gingivectomy procedures have been a challenge for pediatric dentists who confront issues of patient cooperation and discomfort. Treatment of pediatric patients must involve minimal operative and postoperative discomfort. Laser soft-tissue surgery has been shown to be well accepted by children. For the pediatric patient, the greatest advantage of the laser is the lack of local anesthesia injection and the associated pre- and postoperative discomfort. The following case report describes a gingivectomy procedure performed on a 14-year-old female.

  3. IOM Review of FDA--approved biologics labeled or studied for pediatric use.

    PubMed

    Field, Marilyn J; Ellinger, Lara K; Boat, Thomas F

    2013-02-01

    Studies have examined the extent to which public policies such as the Best Pharmaceuticals for Children Act have increased pediatric information in drug labeling. Little attention has focused on pediatric labeling of biologics. This analysis examines the extent to which biologics are labeled for pediatric use or have been studied in children. The analysis covers the 96 biologics (excluding vaccines) that were first licensed by the Food and Drug Administration between 1997 and 2010 and were still marketed as of 2010. Product labeling was consulted for information on approved pediatric uses, pediatric studies, or pediatric safety warnings based on analyses of adverse events. The online database ClinicalTrials.gov was searched for registered pediatric studies of these biologics. A separate analysis examined labeling and studies for 55 vaccines. For ∼60% of the 96 biologics, labeling shows approved pediatric use or pediatric study information or both. Approximately 85% of the biologics have ≥1 registered pediatric trial completed, underway, or planned. Overall, ∼90% are labeled for pediatric use, have pediatric information in the label, have a registered pediatric study, or have some combination of these characteristics. For the 55 analyzed vaccines, the corresponding figure is 95%. A majority of biologics approved in the past 15 years include some pediatric information in their labeling, and pediatric trials have been registered for a substantial majority of these products.

  4. Sedation for Pediatric Endoscopy

    PubMed Central

    2014-01-01

    It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy. PMID:24749082

  5. Pediatric Perioperative Stress Responses and Anesthesia

    PubMed Central

    Yuki, Koichi; Matsunami, Erika; Tazawa, Kazumasa; Wang, Wei; DiNardo, James A.; Koutsogiannaki, Sophia

    2017-01-01

    Summary Surgical stress responses cause an array of endocrinological, metabolic and immunological changes in patients. The landmark studies in the 1980s showed that adequate anesthesia dramatically improved the outcomes of pediatric surgical patients by attenuating stress hormonal responses, pointing out the harm of ‘inadequate’ anesthesia. Subsequent studies questioned the role of administering very high-dose anesthetics to further attenuate stress responses. Here we review the feature of surgical stress responses in pediatric patients including their difference from those in adult patients. Overall, pediatric patients show minimal or no resting energy expenditure change postoperatively. In adult patients, increased resting energy expenditure has been described. Pediatric patients demonstrated robust cortisol and catecholamine responses than adult patients. However, the duration of these surges is often short-lived. Systemic proinflammatory and anti-inflammatory cytokine levels have been measured. Pediatric patients showed less proinflammatory cytokine elevation, but had similar anti-antiinflamatory responses. We also review in detail the immunological changes in response to surgical stress. Based on our current knowledge, we attempted to understand the underlying mechanism how adequate anesthesia dramatically improved the outcome of patients. Although more work is needed to be done, understanding how pediatric patients respond to perioperative stress, and its mechanism and consequence will allow us to direct us into a better, perioperative management in this population. PMID:28217718

  6. Emergency Medical Service Personnel Recognize Pediatric Concussions.

    PubMed

    Speirs, Joshua N; Lyons, Matthew I; Johansson, Bert E

    2017-01-01

    Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed. This first of its kind pilot study was designed to assess EMS personnel's ability to recognize and triage pediatric concussions. Our findings show EMS providers are statistically identical in their ability to recognize and triage concussions to physicians. The performance of our MD participants was lower than expected. Larger studies are needed to further investigate EMS providers' ability to recognize a concussion.

  7. Pediatric intensive care.

    PubMed

    Macintire, D K

    1999-07-01

    To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.

  8. Pediatric cardiopulmonary resuscitation.

    PubMed

    Orlowski, J P

    1983-04-01

    Pediatric cardiopulmonary resuscitation refers to those measures used to restore ventilation and circulation in children. This article defines how cardiopulmonary resuscitation in infants, children, and adolescents differs from cardiopulmonary resuscitation in adults and delineates the drugs and dosages to be used in the resuscitation of pediatric patients.

  9. Pediatric endocrine surgery.

    PubMed

    Telander, R L; Zimmerman, D; Kaufman, B H; van Heerden, J A

    1985-12-01

    The pediatric surgeon is in a unique position to understand endocrine surgery and, therefore, is expected to develop considerable expertise in this area. In recent years numerous advances and changes have occurred in pediatric endocrine surgery that have led to greater understanding of the disease processes and syndromes and the development of new diagnostic techniques and surgical approaches.

  10. Teaching Prevention in Pediatrics.

    ERIC Educational Resources Information Center

    Cheng, Tina L.; Greenberg, Larrie; Loeser, Helen; Keller, David

    2000-01-01

    Reviews methods of teaching preventive medicine in pediatrics and highlights innovative programs. Methods of teaching prevention in pediatrics include patient interactions, self-directed learning, case-based learning, small-group learning, standardized patients, computer-assisted instruction, the Internet, student-centered learning, and lectures.…

  11. Teaching Prevention in Pediatrics.

    ERIC Educational Resources Information Center

    Cheng, Tina L.; Greenberg, Larrie; Loeser, Helen; Keller, David

    2000-01-01

    Reviews methods of teaching preventive medicine in pediatrics and highlights innovative programs. Methods of teaching prevention in pediatrics include patient interactions, self-directed learning, case-based learning, small-group learning, standardized patients, computer-assisted instruction, the Internet, student-centered learning, and lectures.…

  12. [Research in pediatrics].

    PubMed

    Herrera-Márquez, Julia Rocío; González-Cabello, Héctor Jaime

    2015-01-01

    In the interest of encouraging the promotion of research done by physicians of the Instituto Mexicano del Seguro Social, in this supplement we publish articles written by residents of different specialties related to critical themes on pediatrics. These residents are guided by affiliated physicians from the Hospital de Pediatría del Centro Médico Nacional Siglo XXI.

  13. Pediatric Care Online: A Pediatric Point-of-Care Tool.

    PubMed

    Vardell, Emily

    2016-01-01

    Pediatric Care Online is the American Academy of Pediatrics' point-of-care tool designed for health care providers. Pediatric Care Online builds on content from Red Book Online and Pediatric Patient Education and features Quick Reference topic pages for more than 250 pediatric health care topics. The multitude of resources available within Pediatric Care Online will be reviewed in this column, and a sample search will be used to illustrate the type of information available within this point-of-care pediatric resource.

  14. Endovascular management of pediatric aneurysms.

    PubMed

    Saleh, E; Dawson, R C

    2011-10-31

    Although the general principles of endovascular aneurysm treatment in adults hold true in children, these young patients pose unique challenges: small anatomy, longer life expectancy, associated conditions and morphological characteristics of the aneurysms. Few publications in the literature address the role of endovascular treatment for pediatric aneurysms; including series by Agid et al. (2005) (1) revisiting the Toronto series, Lasjaunias et al. (2005) (2) updating the Bicêtre series and Sanai et al (2006) (8) presenting the San Francisco series. In their conclusions, the authors of the former two publications favored endovascular treatment over microsurgery. On the other hand, the authors of the latter publication favored microsurgery over endovascular treatment. The authors reviewed Louisiana State University experience regarding endovascular treatment of pediatric aneurysms focusing on outcomes. A retrospective chart review was performed of children under 18, who underwent endovascular treatment for intracranial aneurysms between 2000 and 2009 in our institution. Twelve patients harboring seventeen aneurysms were identified. The patients ranged in age from seventeen months to seventeen years. Complete aneurysm obliteration following endovascular treatment was around 95%. Our results showed unique features for pediatric aneurysms when compared to adult aneurysms. No intra operative mortality was recorded. One aneurysm recurred (5% recurrence rate among total number of aneurysms). In this case, six months after treatment, a control angiogram showed that the coils were displaced toward the dome of the aneurysm. This recurrence occurred before the introduction of the hydro coils. One patient died during the post intervention period (8% occurrence rate among total number of patients). Outcomes were better in anterior circulation aneurysms than in posterior circulation lesions. We had no mortality, morbidity or disability in the anterior circulation aneurysm group

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

    PubMed

    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

  16. Pediatric liver transplantation outcomes in Korea.

    PubMed

    Kim, Jong Man; Kim, Kyung Mo; Yi, Nam-Joon; Choe, Yon Ho; Kim, Myung Soo; Suh, Kyung Suk; Kim, Soon I I; Lee, Suk-Koo; Lee, Sung-Gyu

    2013-01-01

    Pediatric liver transplantation is the standard of care for treatment of liver failure in children. The aim of this study was to identify the characteristics of pediatric liver transplantation in centers located in Korea and determine factors that influence outcomes. This retrospective study was performed using data from between 1988 and 2010 and included all recipients 18 yr old and younger who underwent pediatric liver transplantation in Korea during that period. Our data sources were hospital medical records and the outcome measure was overall patient survival. Univariate and multivariate statistical analyses were undertaken using the Cox proportional hazards model. Five hundred and thirty-four pediatric liver transplantations were performed in 502 children. Median age and average pediatric end-stage liver disease (PELD) score were 20 months and 18 point, respectively. Biliary atresia (57.7%, 308/534) was the most common cause of liver disease. Eighty-two (15.3%) were deceased donor liver transplantations and 454 (84.7%) were living donor liver transplantations. Retransplantation was performed in 32 cases (6%). Overall, 1-, 5-, and 10-yr patient survival rates were 87.8%, 82.2%, and 78.1%, respectively. In multivariate analysis, independent significant predictors of poor patient survival were chronic rejection and retransplantation. This study presents the epidemiologic data for nearly all pediatric liver transplantation in Korea and shows that the independent prognostic factors in patient survival are chronic rejection and retransplantation.

  17. Musculoskeletal ultrasound in pediatric rheumatology

    PubMed Central

    2011-01-01

    Although musculoskeletal ultrasound (MSUS) has emerged as an indispensible tool among physicians involved in musculoskeletal medicine in the last two decades, only recently has it become more attractive to pediatric rheumatologists. Thereafter, the use of MSUS in pediatric rheumatology has started to increase. Yet, an ever-growing body of literature shows parity and even superiority of MSUS when compared to physical examination and other imaging modalities. MSUS is suitable for examination of children of all ages and it has certain advantages over other imaging modalities; as it is cheaper, mobile, instantly accessible bedside, easy to combine with clinical assessment (interactivity) and non-invasive. It does not require sedation, which facilitates repetitive examinations. Assessment of multiple locations is possible during the same session. Agitation is rarely a problem and small children can be seated in their parents' lap or they can even play while being examined. PMID:21910870

  18. The human mast cell chymase gene (CMA1): Mapping to the cathepsin G/granzyme gene cluster and lineage-restricted expression

    SciTech Connect

    Caughey, G.H.; Schaumberg, T.H.; Zerweck, E.H. ); Butterfield, J.H. ); Hanson, R.D.; Ley, T.J. ); Silverman, G.A. )

    1993-03-01

    Genes encoding T-cell receptor [alpha]/[delta] chains, neutrophil cathepsin G, and lymphocyte CGL/granzymes are closely linked on chromosomal band 14q11.2. The current work identifies the human mast cell chymase gene (CMA1) as the fourth protease in this cluster and maps the gene to within 150 kb of the cathepsin G gene. The gene order is centromere-T cell receptor [alpha]/[delta]-CGL-1/granzyme B-CGL-2/granzyme H-cathepsin G-chymase. Chymase and cathepsin G genes are shown to be cotranscribed in the human mast cell line HMC-1 and in U-937 cells. Other cells transcribe cathepsin G or CGL/granzyme genes, but not chymase genes, suggesting a capacity for independent regulation. Comparison of the 5[prime] flank of the chymase gene with those of cathepsin G and CGL/granzymes reveals little overall homology. Only short regions of the 5[prime] flanks of the human and murine chymase genes sequenced to date are similar, suggesting that they are more distantly related than human and rodent CGL-1/granzyme B, the flanks of which are highly homologous. The expression patterns and clustering of genes provide possible clues to the presence of locus control regions that orchestrate lineage-restricted expression of leukocyte and mast cell proteases. 30 refs., 4 figs., 1 tab.

  19. Pediatric dental chair vs. traditional dental chair: a pediatric dentist's poll.

    PubMed

    Barjatya, Khushboo; Vatsal, Ankur; Kambalimath, Halaswamy V; Kulkarni, Vinay Kumar; Reddy, Naveen Banda

    2015-01-01

    Proper positioning of the child patient, can not only have positive ramifications for the operator's posture, comfort, and career longevity - it can also lead to better treatment and increased productivity. The aim of the survey questionnaire was to assess the utilization, need, and attitude concerning dental chairs among pediatric dentist while working on and managing the child patient. The questions were structured using adobe forms central online software, regarding the user-friendliness of pediatric dental chair vs. traditional adult dental chair available in the market. Our result shows that out of 337 respondents, 79% worked on pediatric dental chair, whereas 21% had no experience of it. Of these 79% pediatric dentist, 48% preferred pediatric dental chair. But pediatric dental problem still has certain disadvantages like higher cost, leg space problem, lower availability, etc. During the research it was found that ergonomics and usability issues were the main problems. Thus, pediatric dental chair is not so popular in the current scenario. This study allowed for general ideas for the improvement of dental chairs and thus improved dental chair would fill the gap in the current scenario.

  20. A Qualitative Study of Healthcare Providers’ Perspectives on the Implications of Genome-Wide Testing in Pediatric Clinical Practice

    PubMed Central

    Reiff, Marian; Mueller, Rebecca; Mulchandani, Surabhi; Spinner, Nancy B.; Pyeritz, Reed E.; Bernhardt, Barbara A.

    2013-01-01

    The utilization of genome-wide chromosomal microarray analysis (CMA) in pediatric clinical practice provides an opportunity to consider how genetic diagnostics is evolving, and to prepare for the clinical integration of genome-wide sequencing technologies. We conducted semi-structured interviews with 15 healthcare providers (7 genetic counselors, 4 medical geneticists, and 4 non-genetics providers) to investigate the impact of CMA on clinical practice, and implications for providers, patients and families. Interviews were analyzed qualitatively using content analysis. Most providers reported that genomic testing enhanced their professional experience and was beneficial to patients, primarily due to the improved diagnostic rate compared with earlier chromosomal studies. Other effects on practice included moving towards genotype-first diagnosis and broadening indications for chromosomal testing. Opinions varied concerning informed consent and disclosure of results. The duty to disclose incidental findings (IFs) was noted; however concerns were raised about potential psychosocial harms of disclosing pre-symptomatic findings. Tensions were revealed between the need for comprehensive informed consent for all families and the challenges of communicating time-consuming and potentially anxiety-provoking information regarding uncertain and incidental findings that may be relevant only in rare cases. Genetic counselors can play an important role in liaising with families, health professionals and testing laboratories, providing education and guidance to non-genetics providers, and enabling families to receive adequate pre- and post-test information and follow-up care. PMID:24037030

  1. Pediatric ventricular assist devices

    PubMed Central

    Burki, Sarah; Zafar, Farhan; Morales, David Luis Simon

    2015-01-01

    The domain of pediatric ventricular assist device (VAD) has recently gained considerable attention. Despite the fact that, historically, the practice of pediatric mechanical circulatory support (MCS) has lagged behind that of adult patients, this gap between the two groups is narrowing. Currently, the Berlin EXCOR VAD is the only pediatric-specific durable VAD approved by the U.S Food and Drug Administration (FDA). The prospective Berlin Heart trial demonstrated a successful outcome, either bridge to transplantation (BTT), or in rare instances, bridge to recovery, in approximately 90% of children. Also noted during the trial was, however, a high incidence of adverse events such as embolic stroke, bleeding and infection. This has incentivized some pediatric centers to utilize adult implantable continuous-flow devices, for instance the HeartMate II and HeartWare HVAD, in children. As a result of this paradigm shift, the outlook of pediatric VAD support has dramatically changed: Treatment options previously unavailable to children, including outpatient management and even destination therapy, have now been becoming a reality. The sustained demand for continued device miniaturization and technological refinements is anticipated to extend the range of options available to children—HeartMate 3 and HeartWare MVAD are two examples of next generation VADs with potential pediatric application, both of which are presently undergoing clinical trials. A pediatric-specific continuous-flow device is also on the horizon: the redesigned Infant Jarvik VAD (Jarvik 2015) is undergoing pre-clinical testing, with a randomized clinical trial anticipated to follow thereafter. The era of pediatric VADs has begun. In this article, we discuss several important aspects of contemporary VAD therapy, with a particular focus on challenges unique to the pediatric population. PMID:26793341

  2. Evaluation of the efficiency of tumor and tissue delivery of carrier-mediated agents (CMA) and small molecule (SM) agents in mice using a novel pharmacokinetic (PK) metric: relative distribution index over time (RDI-OT)

    NASA Astrophysics Data System (ADS)

    Madden, Andrew J.; Rawal, Sumit; Sandison, Katie; Schell, Ryan; Schorzman, Allison; Deal, Allison; Feng, Lan; Ma, Ping; Mumper, Russell; DeSimone, Joseph; Zamboni, William C.

    2014-11-01

    The pharmacokinetics (PK) of carrier-mediated agents (CMA) is dependent upon the carrier system. As a result, CMA PK differs greatly from the PK of small molecule (SM) drugs. Advantages of CMAs over SMs include prolonged circulation time in plasma, increased delivery to tumors, increased antitumor response, and decreased toxicity. In theory, CMAs provide greater tumor drug delivery than SMs due to their prolonged plasma circulation time. We sought to create a novel PK metric to evaluate the efficiency of tumor and tissue delivery of CMAs and SMs. We conducted a study evaluating the plasma, tumor, liver, and spleen PK of CMAs and SMs in mice bearing subcutaneous flank tumors using standard PK parameters and a novel PK metric entitled relative distribution over time (RDI-OT), which measures efficiency of delivery. RDI-OT is defined as the ratio of tissue drug concentration to plasma drug concentration at each time point. The standard concentration versus time area under the curve values (AUC) of CMAs were higher in all tissues and plasma compared with SMs. However, 8 of 17 SMs had greater tumor RDI-OT AUC0-last values than their CMA comparators and all SMs had greater tumor RDI-OT AUC0-6 h values than their CMA comparators. Our results indicate that in mice bearing flank tumor xenografts, SMs distribute into tumor more efficiently than CMAs. Further research in additional tumor models that may more closely resemble tumors seen in patients is needed to determine if our results are consistent in different model systems.

  3. Evaluation of the efficiency of tumor and tissue delivery of carrier-mediated agents (CMA) and small molecule (SM) agents in mice using a novel pharmacokinetic (PK) metric: relative distribution index over time (RDI-OT).

    PubMed

    Madden, Andrew J; Rawal, Sumit; Sandison, Katie; Schell, Ryan; Schorzman, Allison; Deal, Allison; Feng, Lan; Ma, Ping; Mumper, Russell; DeSimone, Joseph; Zamboni, William C

    2014-11-01

    The pharmacokinetics (PK) of carrier-mediated agents (CMA) is dependent upon the carrier system. As a result, CMA PK differs greatly from the PK of small molecule (SM) drugs. Advantages of CMAs over SMs include prolonged circulation time in plasma, increased delivery to tumors, increased antitumor response, and decreased toxicity. In theory, CMAs provide greater tumor drug delivery than SMs due to their prolonged plasma circulation time. We sought to create a novel PK metric to evaluate the efficiency of tumor and tissue delivery of CMAs and SMs. We conducted a study evaluating the plasma, tumor, liver, and spleen PK of CMAs and SMs in mice bearing subcutaneous flank tumors using standard PK parameters and a novel PK metric entitled relative distribution over time (RDI-OT), which measures efficiency of delivery. RDI-OT is defined as the ratio of tissue drug concentration to plasma drug concentration at each time point. The standard concentration versus time area under the curve values (AUC) of CMAs were higher in all tissues and plasma compared with SMs. However, 8 of 17 SMs had greater tumor RDI-OT AUC0-last values than their CMA comparators and all SMs had greater tumor RDI-OT AUC0-6 h values than their CMA comparators. Our results indicate that in mice bearing flank tumor xenografts, SMs distribute into tumor more efficiently than CMAs. Further research in additional tumor models that may more closely resemble tumors seen in patients is needed to determine if our results are consistent in different model systems.

  4. Pediatric Palliative Care

    PubMed Central

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palliative care, but continued research into this important area of pediatrics will lead to improvements in the care of children with life-threatening illnesses. PMID:23118638

  5. Pediatric uveitis: An update

    PubMed Central

    Majumder, Parthopratim Dutta; Biswas, Jyotirmay

    2013-01-01

    Because of their varied spectrum of clinical presentation and difficulty in management, pediatric uveitis remains a challenge to the ophthalmologist. Variations in clinical presentation, difficulties in eye examination, extended burden of the inflammation over quality of life, limited treatment modalities, risk of amblyopia are the main challenges in the management of pediatric uveitis. Pediatric uveitis is a cause of significant ocular morbidity and severe vision loss is found in 25-33% of such cases. This article summarizes the common causes of uveitis in children with special approach to the evaluation and diagnosis of each clinical entity. PMID:24379547

  6. Pediatric body MR angiography.

    PubMed

    Krishnamurthy, Rajesh; Muthupillai, Raja; Chung, Taylor

    2009-02-01

    Vascular pathology in children is commonplace and involves every organ system; however, the powerful, noninvasive, and rapid three-dimensional imaging capability offered by MR angiography is underutilized in children. The success of pediatric MR angiography depends on modifying the MR angiography on the basis of patient size, hemodynamic status, and clinical indications in children, and requires an adequate understanding of pediatric-specific hardware, software, and equipment requirements. This article provides an overview of general pediatric MR angiography techniques, common indications for body MR angiography in children, and the complementary role of MR angiography to other vascular imaging modalities in children, including CT angiography, Doppler ultrasound, and catheter angiography.

  7. Pediatric facial nerve rehabilitation.

    PubMed

    Banks, Caroline A; Hadlock, Tessa A

    2014-11-01

    Facial paralysis is a rare but severe condition in the pediatric population. Impaired facial movement has multiple causes and varied presentations, therefore individualized treatment plans are essential for optimal results. Advances in facial reanimation over the past 4 decades have given rise to new treatments designed to restore balance and function in pediatric patients with facial paralysis. This article provides a comprehensive review of pediatric facial rehabilitation and describes a zone-based approach to assessment and treatment of impaired facial movement. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. [Robotics in pediatric surgery].

    PubMed

    Camps, J I

    2011-10-01

    Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery.

  9. Imaging Pediatric Vascular Lesions

    PubMed Central

    Nguyen, Tuyet A.; Krakowski, Andrew C.; Naheedy, John H.; Kruk, Peter G.

    2015-01-01

    Vascular anomalies are commonly encountered in pediatric and dermatology practices. Most of these lesions are benign and easy to diagnose based on history and clinical exam alone. However, in some cases the diagnosis may not be clear. This may be of particular concern given that vascular anomalies may occasionally be associated with an underlying syndrome, congenital disease, or serious, life-threatening condition. Defining the type of vascular lesion early and correctly is particularly important to determine the optimal approach to management and treatment of each patient. The care of pediatric patients often requires collaboration from a multitude of specialties including pediatrics, dermatology, plastic surgery, radiology, ophthalmology, and neurology. Although early characterization of vascular lesions is important, consensus guidelines regarding the evaluation and imaging of vascular anomalies does not exist to date. Here, the authors provide an overview of pediatric vascular lesions, current classification systems for characterizing these lesions, the various imaging modalities available, and recommendations for appropriate imaging evaluation. PMID:26705446

  10. Pediatric inflammatory bowel disease

    PubMed Central

    Diefenbach, Karen A; Breuer, Christopher K

    2006-01-01

    Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents. The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies, and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn’s disease and ulcerative colitis. Once diagnosed, the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population. Surgical management is usually indicated for failure of medical management, complication, or malignancy. Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented. The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease. PMID:16718840

  11. Pediatric cancer genetics.

    PubMed

    Dean, Sarah J; Farmer, Meagan

    2017-10-04

    The current review will focus on the current knowledge of the contribution of both germline and somatic mutations to the development and management of cancer in pediatric patients. It has long been thought that genetic mutations in both germline and somatic cells can contribute to the development of cancer in pediatric patients. With the recent advances in genomic technologies, there are now over 500 known cancer predisposition genes. Recent studies have confirmed an 8.5-14% germline mutation rate in cancer predisposition genes in pediatric cancer patients. The discovery of both germline and somatic cells mutation(s) in pediatric cancer patients not only aids in the management of current disease, but can also have direct implications for future management as well as the medical management of family members.

  12. Pediatric Salivary Gland Malignancies.

    PubMed

    Ord, Robert A; Carlson, Eric R

    2016-02-01

    Pediatric malignant salivary gland tumors are extremely rare. The percentage of malignant tumors is higher than that seen in adults, although the outcomes in terms of survival are better in pediatric patients. The mainstay of treatment is surgical excision with negative margins. This article reviews current concepts in demographics, etiology, management, and outcomes of malignant salivary tumors in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Advances in pediatric anesthesia.

    PubMed

    Burns, L S

    1997-03-01

    Advances in many aspects of pediatric anesthesia have resulted in a significant reduction in morbidity and mortality in children. Research and development have created vast improvements in pharmacology. Sophisticated monitoring and improvements in equipment evolved from advances made in scientific technology. Recognition of the psychological needs of children of all ages likely has reduced the incidence of lasting psychological effects after hospitalization. Finally, these important advances have made pediatric anesthesia a safer and more compassionate specialty.

  14. A correlation analysis of Broselow™ Pediatric Emergency Tape-determined pediatric weight with actual pediatric weight in India.

    PubMed

    Mishra, Deepak Geetaprasad; Kole, Tamorish; Nagpal, Rahul; Smith, Jeffery Paul

    2016-01-01

    The Broselow™ Pediatric Emergency Tape indicates standardized, pre-calculated medication doses, dose delivery volumes, and equipment sizes using color-coded zones based on height-weight correlations. The present study attempted to provide more evidence on the effectiveness of the Broselow™ Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights. We hypothesized that the Broselow™ Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years, leading to inaccurate dosing and equipment sizing in the emergency setting. This prospective study of pediatric patients aged <10 years who were divided into three groups based on actual body weight: <10 kg, 10-18 kg, and >18 kg. We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias. Concordant results were those with a mean percent difference within 3%. Standard deviation was measured to determine precision. Accuracy was determined as color-coded zone prediction and measured weight concordance, including the percentage overestimation by 1-2 zones. The male-to-female ratio of the patients was 1.3:1. Total agreement between color-coding was 63.18% (κ=0.582). The Broselow™ color-coded zone agreement was 74.8% in the <10 kg group, 61.24% in the 10-18 kg group, and 53.42% in the >18 kg group. The Broselow™ Pediatric Emergency Tape showed good evidence for being more reliable in children of the <10 kg and 10-18 kg groups. However, as pediatric weight increased, predictive reliability decreased. This raises concerns over the use of the Broselow™ Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing >18 kg.

  15. Referral to pediatric surgical specialists.

    PubMed

    Klein, Michael D

    2014-02-01

    The American Academy of Pediatrics, with the collaboration of the Surgical Sections of the American Academy of Pediatrics, has created referral recommendations intended to serve as voluntary practice parameters to assist general pediatricians in determining when and to whom to refer their patients for pediatric surgical specialty care. It is recognized that these recommendations may be difficult to implement, because communities vary in terms of access to major pediatric medical centers. Limited access does not negate the value of the recommendations, however, because the child who needs specialized surgical and anesthetic care is best served by the skills of the appropriate pediatric surgical team. Major congenital anomalies, malignancies, major trauma, and chronic illnesses (including those associated with preterm birth) in infants and children should be managed by pediatric medical subspecialists and pediatric surgical specialists at pediatric referral centers that can provide expertise in many areas, including the pediatric medical subspecialties and surgical specialties of pediatric radiology, pediatric anesthesiology, pediatric pathology, and pediatric intensive care. The optimal management of the child with complex problems, chronic illness, or disabilities requires coordination, communication, and cooperation of the pediatric surgical specialist with the child's primary care pediatrician or physician.

  16. Evaluation of pediatric CPR course on knowledge of pediatric residents--before and after ACLS course.

    PubMed

    Soltani, Alireza Ebrahim; Khan, Zahid Hussain; Arbabi, Shahriar; Hossini, Babak; Nahvi, Hedaiatollah; Agamohammadi, Asghar

    2009-02-01

    An evaluation was conducted on the knowledge gained by pediatric residents on CPR, before and after a PALS (Pediatric Advanced Cardiac Life Support) course. Following an examination of all pediatric residents at Tehran University of Medical Sciences, they were divided into two groups: non-trained (Group 1) and a group scheduled to undergone training (Group 2). A course on ACLS was conducted. Examination were performed before and after the ACLS course. The mean of the examination prior to the course in Group 1 and 2 was low, reflecting no significant differences between the Groups. Examination after the ACLS course showed a statistically significant improvement in Group 2 (P < or = 0.05). It is concluded that knowledge of pediatric residents was low before ACLS course and enhanced after the course.

  17. Pediatric oncology in Turkey.

    PubMed

    Kebudi, Rejin

    2012-03-01

    The survival of children with cancer has increased dramatically in the last decades, as a result of advances in diagnosis, treatment and supportive care. Each year in Turkey, 2500-3000 new childhood cancer cases are expected. According to the Turkish Pediatric Oncology Group and Turkish Pediatric Hematology Societies Registry, about 2000 new pediatric cancer cases are reported each year. The population in Turkey is relatively young. One fourth of the population is younger than 15 years of age. According to childhood mortality, cancer is the fourth cause of death (7.2%) after infections, cardiac deaths and accidents. The major cancers in children in Turkey are leukemia (31%), lymphoma (19%), central nervous system (CNS) neoplasms (13%), neuroblastomas (7%), bone tumors (6.1%), soft tissue sarcomas (6%), followed by renal tumors, germ cell tumors, retinoblastoma, carcinomas-epithelial neoplasms, hepatic tumors and others. Lymphomas rank second in frequency as in many developing countries in contrast to West Europe or USA, where CNS neoplasms rank second in frequency. The seven-year survival rate in children with malignancies in Turkey is 65.8%. The history of modern Pediatric Oncology in Turkey dates back to the 1970's. Pediatric Oncology has been accepted as a subspecialty in Turkey since 1983. Pediatric Oncologists are all well trained and dedicated. All costs for the diagnosis and treatment of children with cancer is covered by the government. Education and infrastructure for palliative care needs improvement.

  18. Pediatric enteral nutrition.

    PubMed

    Axelrod, David; Kazmerski, Kimberly; Iyer, Kishore

    2006-01-01

    Common to all pediatric patients receiving enteral nutrition is the inability to consume calories orally. This is often secondary to issues of inadequate weight gain, inadequate growth, prolonged feeding times, weight loss, a decrease in weight/age or weight/height ratios, or a persistent triceps skinfold thickness <5% for age. Enteral nutrition requires enteral access. In the neonatal period the nasoenteric route is usually used. In pediatric patients requiring long-term enteral access, surgically, endoscopically, or radiologically placed percutaneous feeding tubes are common. Jejunal feeding tubes are used in pediatric patients with gastric feeding intolerance or persistent gastroesophageal reflux. Low-profile enteral access devices are preferred by most pediatric patients because of their cosmetic appearance. For most children, a standard pediatric polypeptide enteral formula is well tolerated. There are specialized pediatric enteral formulas available for patients with decreased intestinal length, altered intestinal absorptive capacity, or altered pancreatic function. Weaning patients from tube feeding to oral nutrition is the ultimate nutrition goal. A multidisciplinary approach to patients with short bowel syndrome will maximize the use of enteral nutrition while preserving parenteral nutrition for patients with true enteral nutrition therapy failure.

  19. What a = 1/298 and C/Ma2 = 0.333 really tell us about the Earth

    USGS Publications Warehouse

    Evernden, J.F.

    1997-01-01

    The discussion in the several versions of The Earth by Jeffreys (third edition, 1952, for example) [1] relative to the ellipticity of the Earth does not demonstrate, as generally believed, that the Earth has the shape of a rotating liquid. His development in conjunction with the work of H. Lamb (1945) [2] shows unequivocally that the Earth is much less oblate than required if it were behaving as a liquid mass. It is not true that the observations of Bouguer in the late 1700's regarding the actual ellipticity of the Earth demonstrated the liquidity of the Earth with mass concentrated towards the center. In fact, proper interpretation of his data would have shown that the Earth's ellipticity results from its great strength, not its weakness. Data available today establish that great strength resides in the lower mantle and has in all probability resided there from the time of the Earth's origin. This strength results in the need for reinterpretation of Earth behavior and operative processes.

  20. Television Quiz Show Simulation

    ERIC Educational Resources Information Center

    Hill, Jonnie Lynn

    2007-01-01

    This article explores the simulation of four television quiz shows for students in China studying English as a foreign language (EFL). It discusses the adaptation and implementation of television quiz shows and how the students reacted to them.

  1. Television Quiz Show Simulation

    ERIC Educational Resources Information Center

    Hill, Jonnie Lynn

    2007-01-01

    This article explores the simulation of four television quiz shows for students in China studying English as a foreign language (EFL). It discusses the adaptation and implementation of television quiz shows and how the students reacted to them.

  2. Pediatric integrative medicine: pediatrics' newest subspecialty?

    PubMed Central

    2012-01-01

    Background Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children’s hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada. Methods Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects. Results Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income. Conclusions Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns. PMID:22894682

  3. Brief Report: Pediatric Cancer Burden and Treatment Resources Within the Pediatric IeDEA Consortium.

    PubMed

    Brown, Steven A; Abbas, Salma; Davies, Mary-Ann; Bunupuradah, Torsak; Sohn, Annette H; Technau, Karl-Günter; Renner, Lorna; Leroy, Valériane; Edmonds, Andrew; Yotebieng, Marcel; McGowan, Catherine C; Duda, Stephany N; Mofenson, Lynne; Musick, Beverly; Wools-Kaloustian, Kara

    2017-09-01

    The incidence and treatment of cancer in HIV-infected children from resource-limited settings has not been extensively studied. Develop and implement a cross-sectional survey to evaluate pediatric cancer burden, diagnostic modalities in use, and treatment availability as perceived by HIV clinic staff at regional International Epidemiology Databases to Evaluate AIDS (IeDEA) sites. IeDEA regional investigators developed a cross-sectional clinical site survey which included questions on the numbers and types of pediatric cancers observed, modalities used to treat identified cancers, and treatment options available at individual sites in the Asia-Pacific, Latin America, Central Africa, East Africa, West Africa, and Southern Africa regions. Kaposi sarcoma, non-Hodgkin lymphoma, and Burkitt lymphoma were reported by site personnel to be the most prevalent types of cancer in the pediatric HIV population. Survey results indicate that access to comprehensive cancer treatment modalities is very limited for children in these regions despite HIV care and treatment sites reporting that they diagnose pediatric cancers. Responses also showed that evaluating cancer in the pediatric HIV population is a challenge due to a lack of resources and varying treatment availability within regions. Further study is needed to increase our understanding of the changing epidemiology of cancer in HIV-infected pediatric populations. Increased financial and technical resources are critical to aid in the advancement of health services to support treatment of these children in resource-constrained settings.

  4. Adolescent and Pediatric Brain Tumors

    MedlinePlus

    ... Children Pediatric Brain Tumor Diagnosis Family Impact Late Effects After Treatment Returning to School Pediatric Caregiver Resource Center About Us Our Founders Board of Directors Staff Leadership Strategic Plan Financials ...

  5. Pediatric Antimicrobial Stewardship Programs

    PubMed Central

    Nichols, Kristen; Stoffella, Sylvia; Meyers, Rachel; Girotto, Jennifer

    2017-01-01

    The frequent use of antimicrobials in pediatric patients has led to a significant increase in multidrug-resistant bacterial infections among children. Antimicrobial stewardship programs have been created in many hospitals in an effort to curtail and optimize the use of antibiotics. Pediatric-focused programs are necessary because of the differences in antimicrobial need and use among this patient population, unique considerations and dosing, vulnerability for resistance due to a lifetime of antibiotic exposure, and the increased risk of adverse events. This paper serves as a position statement of the Pediatric Pharmacy Advocacy Group (PPAG) who supports the implementation of antimicrobial stewardship programs for all pediatric patients. PPAG also believes that a pediatric pharmacy specialist should be included as part of that program and that services be covered by managed care organizations and government insurance entities. PPAG also recommends that states create legislation similar to that in existence in California and Missouri and that a federal Task Force for Combating Antibiotic-Resistant Bacteria be permanently established. PPAG also supports post-doctoral pharmacy training programs in antibiotic stewardship.

  6. Pediatric Sleep Apnea

    PubMed Central

    Ievers-Landis, Carolyn E.; Redline, Susan

    2007-01-01

    Over the last 30 years, the prevalence of overweight across all pediatric age groups and ethnicities has increased substantially, with the current prevalence of overweight among adolescents estimated to be approximately 30%. Current evidence suggests that overweight is modestly associated with obstructive sleep apnea syndrome (OSAS) among young children, but strongly associated with OSAS in older children and adolescents. The rising incidence of pediatric overweight likely will impact the prevalence, presentation, and treatment of childhood OSAS. The subgroup of children who may be especially susceptible include ethnic minorities and those from households with caregivers from low socioeconomic groups. OSAS, by exposing children to recurrent intermittent hypoxemia or oxidative stress, may amplify the adverse effects of adiposity on systemic inflammation and metabolic perturbations associated with vascular disease and diabetes. When these conditions manifest early in life, they have the potential to alter physiology at critical developmental stages, or, if persistent, provide cumulative exposures that may powerfully alter long-term health profiles. An increased prevalence of overweight also may impact the response to adenotonsillectomy as a primary treatment for childhood OSAS. The high and anticipated increased prevalence of pediatric OSAS mandates assessment of optimal approaches for preventing and treating both OSAS and overweight across the pediatric age range. In this Pulmonary Perspective, the interrelationships between pediatric OSAS and overweight are reviewed, and the implications of the overweight epidemic on childhood OSAS are discussed. PMID:17158283

  7. [History of pediatric anesthesiology].

    PubMed

    Simić, Dusica; Dragović, Simon; Budić, Ivana

    2007-01-01

    Among advances in medicine during the past 150 years, certainly the introduction of surgical anesthesia must be considered the greatest gifts of medical profession to mankind, especially to children. Pediatric anesthesia has progressed rapidly throughout the years. Since the first recorded case of pediatric anesthesia in 1842 to the latest advancement in training, technology, medicine and equipment in the last decades of this century, many historic moments have been following each other. Throughout the first decades of 20th century, most physicians treated children as miniature adults. It is believed that the development of modern pediatric anesthesia started in 1930. To offer a historic perspective, the evolution of new field through its rapid growth was divided into two chronologic categories: first (1930-1950) and second (1950-present). During the first period (1930-1950), the anesthesia techniques and equipment adjusted to different children's age were developed. In the second, together with further technique and equipment refinement, modern anesthetics and vital system surveillance (monitoring) were introduced into everyday practice. The keyto the advances in pediatric anesthesiology was difficulties leading to new inventions with consequent improvement of techniques and methods. This article reviews the origins and development of anesthesia for infants and children in the world and Serbia, emphasizing the contributions of many devoted physicians that represented the major force leading to inevitable evolution of pediatric anesthesia.

  8. Pediatric Electrocardiographic Imaging (ECGI) Applications

    PubMed Central

    Silva, Jennifer N. A.

    2014-01-01

    Summary Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: 1) ECGI in patients with congenital heart disease and Wolff-Parkinson-White syndrome, 2) ECGI in patients with hypertrophic cardiomyopathy and pre-excitation, 3) ECGI in pediatric patients with Wolff-Parkinson-White syndrome, and 4) ECGI for pediatric cardiac resynchronization therapy. PMID:25722754

  9. Failed Pediatric Drug Development Trials.

    PubMed

    Momper, J D; Mulugeta, Y; Burckart, G J

    2015-09-01

    Pediatric product development initiatives have stimulated the development of therapies for children, resulting in improved product labeling, increased identification of adverse events, and development of new pediatric formulations. However, 42% of recently completed pediatric trials have failed to establish either safety or efficacy, leading to an inability to label the product for use in children.(1) Characterizing these failed trials, including common contributing factors, is imperative to designing better pediatric trials in the future. © 2015 American Society for Clinical Pharmacology and Therapeutics.

  10. Idiopathic thoracic aortic aneurysm at pediatric age.

    PubMed

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  11. Pharmacologic Treatment for Pediatric Gastroparesis: A Review of the Literature

    PubMed Central

    Smetana, Keaton S.; Bantu, Likeselam; Buckley, Merrion G.

    2016-01-01

    There have been a number of agents that have been tried for treatment of gastroparesis over the past 3 decades, with varying levels of success. Guidelines exist for the management of gastroparesis in adults; however, even though the cause of gastroparesis in children is similar to that in adults, no guidelines exist for treating pediatric gastroparesis as studies on the topic are limited. With what little information we have on pediatric gastroparesis, medications used in children's studies do not seem to demonstrate the same results as in adult patients with gastroparesis; thus, future studies of whether certain medications are effective for treating pediatric gastroparesis and at what dose still need to be conducted. Pharmacological treatment options for pediatric gastroparesis do not show a clear correlation of resolving or even maintaining gastroparesis-associated symptoms or disease state. This article reviews the available studies of drugs that have shown some efficacy, with an emphasis on pediatric studies. PMID:27199619

  12. Pharmacologic Treatment for Pediatric Gastroparesis: A Review of the Literature.

    PubMed

    Tillman, Emma M; Smetana, Keaton S; Bantu, Likeselam; Buckley, Merrion G

    2016-01-01

    There have been a number of agents that have been tried for treatment of gastroparesis over the past 3 decades, with varying levels of success. Guidelines exist for the management of gastroparesis in adults; however, even though the cause of gastroparesis in children is similar to that in adults, no guidelines exist for treating pediatric gastroparesis as studies on the topic are limited. With what little information we have on pediatric gastroparesis, medications used in children's studies do not seem to demonstrate the same results as in adult patients with gastroparesis; thus, future studies of whether certain medications are effective for treating pediatric gastroparesis and at what dose still need to be conducted. Pharmacological treatment options for pediatric gastroparesis do not show a clear correlation of resolving or even maintaining gastroparesis-associated symptoms or disease state. This article reviews the available studies of drugs that have shown some efficacy, with an emphasis on pediatric studies.

  13. Pediatric Euthanasia and Palliative Care Can Work Together.

    PubMed

    Hanson, Stephen S

    2016-06-01

    Since the Netherlands produced the Groningen protocol describing the methods to be used for pediatric euthanasia and Belgium passed laws authorizing euthanasia for children who consent to it, the issue of pediatric euthanasia has become a relevant topic to discuss. Most rejections of pediatric euthanasia fall into 1 or more of 3 categories, each of which has problems. This article shows how several recent arguments against pediatric euthanasia fail to prove that pediatric euthanasia is unacceptable. It does not follow from this that the practice is permissible but rather that if one is to reject such a practice, stronger arguments will need to be made, especially in countries where adult euthanasia or assisted suicide is already permitted. © The Author(s) 2015.

  14. A Holographic Road Show.

    ERIC Educational Resources Information Center

    Kirkpatrick, Larry D.; Rugheimer, Mac

    1979-01-01

    Describes the viewing sessions and the holograms of a holographic road show. The traveling exhibits, believed to stimulate interest in physics, include a wide variety of holograms and demonstrate several physical principles. (GA)

  15. A Holographic Road Show.

    ERIC Educational Resources Information Center

    Kirkpatrick, Larry D.; Rugheimer, Mac

    1979-01-01

    Describes the viewing sessions and the holograms of a holographic road show. The traveling exhibits, believed to stimulate interest in physics, include a wide variety of holograms and demonstrate several physical principles. (GA)

  16. What Is a Pediatric Endocrinologist?

    MedlinePlus

    ... dealing with children and in treating children with endocrine disorders and hormonal problems. If your pediatrician suggests that your child see a pediatric endocrinologist, you can be assured that your child will receive the best possible care. To find a pediatrician or pediatric specialist in ... © Copyright 2017 American Academy of Pediatrics. All rights reserved.

  17. Physician Requirements-1990. For Pediatrics.

    ERIC Educational Resources Information Center

    Rudzinski, Karen; Thorner, Robert N.

    Professional requirements for physicians specializing in pediatrics were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for pediatrics, the pediatrics Delphi panel reviewed reference and incidence-prevalence and utilization data for 230 conditions that affect the…

  18. What's new in pediatric orthopaedics.

    PubMed

    Sanders, James O; Otsuka, Norman Y; Martus, Jeffrey E

    2015-02-18

    This past year has seen an increase in the quality of studies in pediatric orthopaedics, and the completion of BrAIST demonstrated that high-level studies of important questions can be addressed in pediatric orthopaedics. The current commitment of improving quality of care for children promises a healthy future for pediatric orthopaedics.

  19. Integrative Pediatrics: Looking Forward

    PubMed Central

    McClafferty, Hilary

    2015-01-01

    Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have accelerated research in the field of pediatric integrative medicine. This emerging field can be defined as healing-oriented medicine that considers the whole child, including all elements of lifestyle and family health. It is informed by evidence and carefully weighs all appropriate treatment options. This Special Issue of Children, containing a collection of articles written by expert clinicians, represents an important educational contribution to the field. The goal of the edition is to raise awareness about integrative topics with robust supporting evidence, and to identify areas where more research is needed. PMID:27417349

  20. Pediatric nuclear medicine

    SciTech Connect

    Not Available

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  1. Sleeping beauties in pediatrics.

    PubMed

    Završnik, Jernej; Kokol, Peter

    2016-10-01

    Sleeping beauties (SBs) in science have been known for few decades; however, it seems that only recently have they become popular. An SB is a publication that "sleeps" for a long time and then almost suddenly awakes and becomes highly cited. SBs present interesting findings in science. Pediatrics research literature has not yet been analyzed for their presence, and 5 pediatrics SBs were discovered in this research. Their prevalence was approximately 0.011%. Some environments or periods are more "SB fertile" than others: 3 of 5 SBs were published in the journal Pediatrics, 4 originated from the United States, and 4 were published in the period from 1992 to 1993. No institutions or authors published more than 1 SB.

  2. Sleeping beauties in pediatrics

    PubMed Central

    Završnik, Jernej; Kokol, Peter

    2016-01-01

    Sleeping beauties (SBs) in science have been known for few decades; however, it seems that only recently have they become popular. An SB is a publication that “sleeps” for a long time and then almost suddenly awakes and becomes highly cited. SBs present interesting findings in science. Pediatrics research literature has not yet been analyzed for their presence, and 5 pediatrics SBs were discovered in this research. Their prevalence was approximately 0.011%. Some environments or periods are more “SB fertile” than others: 3 of 5 SBs were published in the journal Pediatrics, 4 originated from the United States, and 4 were published in the period from 1992 to 1993. No institutions or authors published more than 1 SB. PMID:27822155

  3. Pediatric considerations in homecare.

    PubMed

    Petit de Mange, E A

    1998-09-01

    "If I had known beforehand how difficult, demanding, time consuming, and exhausting it would be--having my child home on a ventilator--I would never have agreed to bring her home" (personal communication with a parent, 1994). This mother's statement strikes at the heart of pediatric high-tech homecare. Parents assume caregiver roles that professional health providers have taken years to develop. Nurses, as strangers, intrude into intimate family relationships that have cultivated over years. Pioneering agencies attempt to fill a gap in pediatric care using guidelines that have been entrenched in the medical and economic models for years. The multiple dimensions of high-tech pediatric homecare require more than provision of technical nursing services. In homecare, nurses are challenged by cultural differences, language barriers, loss of control, family dynamics, practicing in unfamiliar environments, and new technology. To ensure quality nursing care, all professional dimensions need to be considered to be of equal importance.

  4. Pediatric Integrative Medicine.

    PubMed

    McClafferty, Hilary; Vohra, Sunita; Bailey, Michelle; Brown, Melanie; Esparham, Anna; Gerstbacher, Dana; Golianu, Brenda; Niemi, Anna-Kaisa; Sibinga, Erica; Weydert, Joy; Yeh, Ann Ming

    2017-09-01

    The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to this mission, the American Academy of Pediatrics recognizes the increasing use of complementary and integrative therapies for children and the subsequent need to provide reliable information and high-quality clinical resources to support pediatricians. This Clinical Report serves as an update to the original 2008 statement on complementary medicine. The range of complementary therapies is both extensive and diverse. Therefore, in-depth discussion of each therapy or product is beyond the scope of this report. Instead, our intentions are to define terms; describe epidemiology of use; outline common types of complementary therapies; review medicolegal, ethical, and research implications; review education and training for select providers of complementary therapies; provide educational resources; and suggest communication strategies for discussing complementary therapies with patients and families. Copyright © 2017 by the American Academy of Pediatrics.

  5. Pediatric thoracoabdominal biomechanics.

    PubMed

    Kent, Richard; Salzar, Robert; Kerrigan, Jason; Parent, Daniel; Lessley, David; Sochor, Mark; Luck, Jason F; Loyd, Andre; Song, Yin; Nightingale, Roger; Bass, Cameron R; Maltese, Matthew R

    2009-11-01

    No experimental data exist quantifying the force-deformation behavior of the pediatric chest when subjected to non-impact, dynamic loading from a diagonal belt or a distributed loading surface. Kent et al. (2006) previously published juvenile abdominal response data collected using a porcine model. This paper reports on a series of experiments on a 7-year-old pediatric post-mortem human subject (PMHS) undertaken to guide the scaling of existing adult thoracic response data for application to the child and to assess the validity of the porcine abdominal model. The pediatric PMHS exhibited abdominal response similar to the swine, including the degree of rate sensitivity. The upper abdomen of the PMHS was slightly stiffer than the porcine behavior, while the lower abdomen of the PMHS fit within the porcine corridor. Scaling of adult thoracic response data using any of four published techniques did not successfully predict the pediatric behavior. All of the scaling techniques intrinsically reduce the stiffness of the adult response, when in reality the pediatric subject was as stiff as, or slightly more stiff than, published adult corridors. An assessment of age-related changes in thoracic stiffness indicated that for both a CPR patient population and dynamic diagonal belt loading on a PMHS population, the effective stiffness of the chest increases through the fourth decade of life and then decreases, resulting in stiffness values approximately the same for children and for elderly adults. Additional research is needed to elucidate the generality of this finding and to assess its significance for scaling adult data to represent pediatric responses.

  6. Pediatric bipolar disorder.

    PubMed

    Carbray, M Julie A; McGuinness, Teena

    2009-12-01

    Pediatric bipolar disorder differs from the adult form of the disorder, marked by longer episodes, rapid cycling, prominent irritability, and high rates of comorbid attention-deficit/hyperactivity disorder and anxiety disorders. A careful assessment by families of children's symptoms, including their duration and intensity, helps with accurate diagnosis. After the diagnosis is made and careful psychopharmacological intervention is initiated, psychiatric nursing treatment of children and adolescents with pediatric bipolar disorder should involve child-and family-focused cognitive-behavioral therapies, family support, and psychoeducation.

  7. Children's rights in pediatrics.

    PubMed

    Streuli, Jürg C; Michel, Margot; Vayena, Effy

    2011-01-01

    The United Nations Convention of Children's Rights (UNCRC) introduced in 1989 has generated a global movement for the protection of children's rights and has brought about a paradigm change in how children are perceived. Pediatric healthcare professionals are interacting with children and therefore with children's rights on a daily basis. However, although at least 18 of the 54 articles are relevant for pediatric practice, there is limited systematic training on how pediatricians can support children's rights in the clinical setting. This article discusses the principles and aims of the UNCRC and proposes a comprehensive checklist of rights vis-à-vis issues that arise in clinical practice.

  8. Pediatric Extranodal Lymphoma.

    PubMed

    Chung, Ellen M; Pavio, Michael

    2016-07-01

    Lymphoma is the third most common pediatric neoplasm. Non-Hodgkin lymphoma (NHL) accounts for nearly half of cases and commonly involves extranodal sites. Compared with adults, this histologic spectrum of pediatric NHL is very narrow and consists of aggressive tumors. Patients typically present with widespread disease. Generally, NHL occurring in children includes Burkitt lymphoma, lymphoblastic lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma. Staging and assessment of therapeutic response are usually based on FDG-PET/CT. Due to the increased susceptibility of young patients to the effects of ionizing radiation, alternative methods of imaging are being explored. Published by Elsevier Inc.

  9. Pediatric Gastric Teratoma

    PubMed Central

    Valenzuela-Ramos, Marco Cesar; Mendizábal-Méndez, Ana Luisa; Ríos-Contreras, Carlos Alberto; Rodríguez-Montes, Claudia Esther

    2010-01-01

    Neoplasms from germ cell origin are a heterogeneous group of tumors rarely seen in the pediatric population, teratoma is the most frequent among them. They can occur in either gonadal or extragonadal locations. Extragonadal teratoma arising from abdominal viscera is very unusual. There are less than a hundred reported cases of gastric teratoma in the worldwide literature. Since the occurrence of this pathology in the pediatric age group is quite rare, we describe a case of a teratoma located in the lesser curvature of the stomach in an infant with an emphasis in radiologic-pathologic correlation. PMID:22470691

  10. Pediatric palliative care.

    PubMed

    Moody, Karen; Siegel, Linda; Scharbach, Kathryn; Cunningham, Leslie; Cantor, Rabbi Mollie

    2011-06-01

    Progress in pediatric palliative care has gained momentum, but there remain significant barriers to the appropriate provision of palliative care to ill and dying children, including the lack of properly trained health care professionals, resources to finance such care, and scientific research, as well as a continued cultural denial of death in children. This article reviews the epidemiology of pediatric palliative care, special communication concerns, decision making, ethical and legal considerations, symptom assessment and management, psychosocial issues, provision of care across settings, end-of-life care, and bereavement. Educational and supportive resources for health care practitioners and families, respectively, are included.

  11. Pediatric Orbital Fractures

    PubMed Central

    Oppenheimer, Adam J.; Monson, Laura A.; Buchman, Steven R.

    2013-01-01

    It is wise to recall the dictum “children are not small adults” when managing pediatric orbital fractures. In a child, the craniofacial skeleton undergoes significant changes in size, shape, and proportion as it grows into maturity. Accordingly, the craniomaxillofacial surgeon must select an appropriate treatment strategy that considers both the nature of the injury and the child's stage of growth. The following review will discuss the management of pediatric orbital fractures, with an emphasis on clinically oriented anatomy and development. PMID:24436730

  12. Orthobiologics in Pediatric Orthopedics.

    PubMed

    Murphy, Robert F; Mooney, James F

    2017-07-01

    Orthobiologics are biologic devices or products used in orthopedic surgery to augment or enhance bone formation. The use of orthobiologics in pediatric orthopedics is less frequent than in other orthopedic subspecialties, mainly due to the naturally abundant healing potential and bone formation in children compared with adults. However, orthobiologics are used in certain situations in pediatric orthopedics, particularly in spine and foot surgery. Other uses have been reported in conjunction with specific procedures involving the tibia and pelvis. The use of bioabsorable implants to stabilize children's fractures is an emerging concept but has limited supporting data. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Tracheostomy: pediatric considerations.

    PubMed

    Deutsch, Ellen S

    2010-08-01

    Pediatric patients for whom tracheotomy is a consideration have different anatomy, medical conditions, and prognoses than adults; even the tracheotomy tubes are different. Indications for pediatric tracheotomy generally include bypassing airway obstruction, providing access for prolonged mechanical ventilation, and facilitating tracheobronchial toilet. Subglottic stenosis is an important indication for tracheotomy in children; its etiology, prevention, and alternative options for management are presented. Discussion includes the benefits, risks, impact on families, techniques for tracheotomy tube changes, and alternatives to tracheotomy, with illustrative photographs and diagrams.

  14. Show Me the Way

    ERIC Educational Resources Information Center

    Dicks, Matthew J.

    2005-01-01

    Because today's students have grown up steeped in video games and the Internet, most of them expect feedback, and usually gratification, very soon after they expend effort on a task. Teachers can get quick feedback to students by showing them videotapes of their learning performances. The author, a 3rd grade teacher describes how the seemingly…

  15. Stage a Water Show

    ERIC Educational Resources Information Center

    Frasier, Debra

    2008-01-01

    In the author's book titled "The Incredible Water Show," the characters from "Miss Alaineus: A Vocabulary Disaster" used an ocean of information to stage an inventive performance about the water cycle. In this article, the author relates how she turned the story into hands-on science teaching for real-life fifth-grade students. The author also…

  16. The Ozone Show.

    ERIC Educational Resources Information Center

    Mathieu, Aaron

    2000-01-01

    Uses a talk show activity for a final assessment tool for students to debate about the ozone hole. Students are assessed on five areas: (1) cooperative learning; (2) the written component; (3) content; (4) self-evaluation; and (5) peer evaluation. (SAH)

  17. Chemistry Game Shows

    NASA Astrophysics Data System (ADS)

    Campbell, Susan; Muzyka, Jennifer

    2002-04-01

    We present a technological improvement to the use of game shows to help students review for tests. Our approach uses HTML files interpreted with a browser on a computer attached to an LCD projector. The HTML files can be easily modified for use of the game in a variety of courses.

  18. Showing What They Know

    ERIC Educational Resources Information Center

    Cech, Scott J.

    2008-01-01

    Having students show their skills in three dimensions, known as performance-based assessment, dates back at least to Socrates. Individual schools such as Barrington High School--located just outside of Providence--have been requiring students to actively demonstrate their knowledge for years. The Rhode Island's high school graduating class became…

  19. Honored Teacher Shows Commitment.

    ERIC Educational Resources Information Center

    Ratte, Kathy

    1987-01-01

    Part of the acceptance speech of the 1985 National Council for the Social Studies Teacher of the Year, this article describes the censorship experience of this honored social studies teacher. The incident involved the showing of a videotape version of the feature film entitled "The Seduction of Joe Tynan." (JDH)

  20. Honored Teacher Shows Commitment.

    ERIC Educational Resources Information Center

    Ratte, Kathy

    1987-01-01

    Part of the acceptance speech of the 1985 National Council for the Social Studies Teacher of the Year, this article describes the censorship experience of this honored social studies teacher. The incident involved the showing of a videotape version of the feature film entitled "The Seduction of Joe Tynan." (JDH)

  1. Talk Show Science.

    ERIC Educational Resources Information Center

    Moore, Mitzi Ruth

    1992-01-01

    Proposes having students perform skits in which they play the roles of the science concepts they are trying to understand. Provides the dialog for a skit in which hot and cold gas molecules are interviewed on a talk show to study how these properties affect wind, rain, and other weather phenomena. (MDH)

  2. What Do Maps Show?

    ERIC Educational Resources Information Center

    Geological Survey (Dept. of Interior), Reston, VA.

    This curriculum packet, appropriate for grades 4-8, features a teaching poster which shows different types of maps (different views of Salt Lake City, Utah), as well as three reproducible maps and reproducible activity sheets which complement the maps. The poster provides teacher background, including step-by-step lesson plans for four geography…

  3. Pediatric Readiness and Facility Verification.

    PubMed

    Remick, Katherine; Kaji, Amy H; Olson, Lenora; Ely, Michael; Schmuhl, Patricia; McGrath, Nancy; Edgerton, Elizabeth; Gausche-Hill, Marianne

    2016-03-01

    We perform a needs assessment of pediatric readiness, using a novel scoring system in California emergency departments (EDs), and determine the effect of pediatric verification processes on pediatric readiness. ED nurse managers from all 335 acute care hospital EDs in California were sent a 60-question Web-based assessment. A weighted pediatric readiness score (WPRS), using a 100-point scale, and gap analysis were calculated for each participating ED. Nurse managers from 90% (300/335) of EDs completed the Web-based assessment, including 51 pediatric verified EDs, 67 designated trauma centers, and 31 EDs assessed for pediatric capabilities. Most pediatric visits (87%) occurred in nonchildren's hospitals. The overall median WPRS was 69 (interquartile ratio [IQR] 57.7, 85.9). Pediatric verified EDs had a higher WPRS (89.6; IQR 84.1, 94.1) compared with nonverified EDs (65.5; IQR 55.5, 76.3) and EDs assessed for pediatric capabilities (70.7; IQR 57.4, 88.9). When verification status and ED volume were controlled for, trauma center designation was not predictive of an increase in the WPRS. Forty-three percent of EDs reported the presence of a quality improvement plan that included pediatric elements, and 53% reported a pediatric emergency care coordinator. When coordinator and quality improvement plan were controlled for, the presence of at least 1 pediatric emergency care coordinator was associated with a higher WPRS (85; IQR 75, 93.1) versus EDs without a coordinator (58; IQR 50.1, 66.9), and the presence of a quality improvement plan was associated with a higher WPRS (88; IQR 76.7, 95) compared with that of hospitals without a plan (62; IQR 51.2, 68.7). Of pediatric verified EDs, 92% had a quality improvement plan for pediatric emergency care and 96% had a pediatric emergency care coordinator. We report on the first comprehensive statewide assessment of "pediatric readiness" in EDs according to the 2009 "Guidelines for Care of Children in the Emergency Department

  4. Mars Slide Show

    NASA Technical Reports Server (NTRS)

    2006-01-01

    15 September 2006 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a landslide that occurred off of a steep slope in Tithonium Chasma, part of the vast Valles Marineris trough system.

    Location near: 4.8oS, 84.6oW Image width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Autumn

  5. The future of pediatric research.

    PubMed

    Boat, Thomas F

    2007-11-01

    The future of pediatric research will be enhanced by strengthening traditional biomedical approaches and embracing emerging opportunities. Biomedical discovery and translation of new knowledge, concepts, and devices into better diagnostic and therapeutic options will require more pediatric physician-scientists, rapid adoption of enabling technologies, increased funding for research and research training (including the creation of federally funded pediatric translational research centers), and a broader distribution of research activities across the academic pediatric community. Rapid improvement of child health outcomes also will be realized through robust health services research in pediatrics, including the application of rigorous quality improvement science that documents and disseminates successful interventions, leading to better access and effectiveness of care. Improving the value of pediatric care is a realistic goal. Achieving better outcomes through individually tailored (personalized) care for children should be tested experimentally. The future of pediatrics is bright, but will depend on the recognition of and response to a growing array of exciting opportunities.

  6. Intestinal obstruction (pediatric) - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100165.htm Intestinal obstruction (pediatric) - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  7. Pharmacotherapy of Pediatric Insomnia

    ERIC Educational Resources Information Center

    Owens, Judith A.

    2009-01-01

    General guidelines for the use of medication to treat pediatric insomnia are presented. It should be noted that medication is not the first treatment choice and should be viewed within the context of a more comprehensive treatment plan. The pharmacological and clinical properties of over the counter medications and FDA-approved insomnia drugs are…

  8. Pharmacotherapy of Pediatric Insomnia

    ERIC Educational Resources Information Center

    Owens, Judith A.

    2009-01-01

    General guidelines for the use of medication to treat pediatric insomnia are presented. It should be noted that medication is not the first treatment choice and should be viewed within the context of a more comprehensive treatment plan. The pharmacological and clinical properties of over the counter medications and FDA-approved insomnia drugs are…

  9. The pediatric red eye.

    PubMed

    Wong, Melissa M; Anninger, William

    2014-06-01

    There is a broad differential for the pediatric red eye, which may range from benign conditions to vision- and/or life-threatening conditions. This article presents a systematic differential, red flags for referral, and treatment options. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Pediatric Glaucoma: Pharmacotherapeutic Options.

    PubMed

    Samant, Monica; Medsinge, Anagha; Nischal, Ken K

    2016-06-01

    Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.

  11. Pediatric primary gastric lymphoma.

    PubMed

    Harris, G J; Laszewski, M J

    1992-04-01

    Primary gastric lymphoma in the pediatric population is rare. We have described a case of non-Hodgkin's lymphoma (Burkitt's type) manifested as a gastric mass. Despite its rarity in children, this tumor should be treated aggressively, since long-term survival has been reported.

  12. Pediatric sleep pharmacology.

    PubMed

    Pelayo, Rafael; Yuen, Kin

    2012-10-01

    This article reviews common sleep disorders in children and pharmacologic options for them. Discussions of pediatric sleep pharmacology typically focus on treatment of insomnia. Although insomnia is a major concern in this population, other conditions of concern in children are presented, such as narcolepsy, parasomnias, restless legs syndrome, and sleep apnea.

  13. Pediatric functional gastrointestinal disorders

    USDA-ARS?s Scientific Manuscript database

    Functional gastrointestinal disorders continue to be a prevalent set of conditions faced by the healthcare team and have a significant emotional and economic impact. In this review, the authors highlight some of the common functional disorders seen in pediatric patients (functional dyspepsia, irrita...

  14. Pediatric Urinary Tract Infection

    MedlinePlus

    SBA National Resource Center: 800-621-3141 Pediatric Urinary Tract Infections and Catheterization in Children with Neurogenic Bladder and ... To protect the kidneys from damage – By preventing urinary tract infections (UTI) – By identifying and treating vesicoureteral remux (VUR). ...

  15. Update on pediatric hyperhidrosis.

    PubMed

    Gordon, Jennifer R S; Hill, Samantha E

    2013-01-01

    Hyperhidrosis is a common and under-recognized disease in the pediatric population that has a significant impact on quality of life. Focal and generalized forms of hyperhidrosis exist, which can be idiopathic or secondary to underlying medical conditions or medications. Treatment is tailored to the specific patient needs, characteristics and goals. These include topical preparations, iontophoresis, botulinum toxin and anticholinergic medications.

  16. Pediatric heart surgery

    MedlinePlus

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  17. A prospective study on the attitude of post graduates in general pediatrics toward pediatric oncology subspeciality as a career.

    PubMed

    Thirugnanasambandam, Ram Prakash; Latha, Magatha Sneha; Moorthy, Aravind; Kannan, Lakshminarayanan; Paramasivam, Venkataraman; Scott, Julius Xavier

    2014-01-01

    The health care scenario in India is experiencing an increase in the number of children affected with cancer and the number of pediatric oncologists available to treat these children are few and the awareness of childhood cancer is decimally low. Hence, the purpose of this study was to determine the attitude of post-graduate students of general pediatrics towards childhood cancer and to assess their interest in pursuing pediatric oncology as a specialty in their carrier. The study was conducted among 188 post-graduates hailing from various Medical colleges all over South India who were attending a 2 day workshop at Chennai. The survey was a 10 point questionnaire pertaining to their previous training, competence, interest toward the field of hematooncology. The data were analyzed by SPSS 18.V software. Among the post-graduates, 74.7% of them reported that they did not have a pediatric oncology unit in their institution. 63.3% reported that they never been posted in pediatric oncology clinical postings before. 62% were not interested in pursuing pediatric oncology as a sub-specialty at all. 45.3% felt that pediatric oncology was too depressing to take as a specialty. 46.7% felt that late diagnosis and referral was the main factor which contributed to the failure of effective treatment of childhood cancers. 52.7% had never attended a class on pediatric oncology. 61.3% felt that they did not have sufficient knowledge to suspect and refer a child with cancer. 92% felt that there was a need to improve pediatric oncology teaching in their curriculum. 56.7% felt that the best way to imprint awareness on childhood malignancies was to improve pediatric oncology teaching in their medical curriculum. The results show that majority of post-graduates in pediatrics were not interested in pursuing pediatric oncology as a sub-specialty. The main reasons may be lack of specialized Pediatric oncology units in the majority of the medical institutions, lack of opportunity of these

  18. Not a "reality" show.

    PubMed

    Wrong, Terence; Baumgart, Erica

    2013-01-01

    The authors of the preceding articles raise legitimate questions about patient and staff rights and the unintended consequences of allowing ABC News to film inside teaching hospitals. We explain why we regard their fears as baseless and not supported by what we heard from individuals portrayed in the filming, our decade-long experience making medical documentaries, and the full un-aired context of the scenes shown in the broadcast. The authors don't and can't know what conversations we had, what documents we reviewed, and what protections we put in place in each televised scene. Finally, we hope to correct several misleading examples cited by the authors as well as their offhand mischaracterization of our program as a "reality" show.

  19. XMM on show

    NASA Astrophysics Data System (ADS)

    1998-01-01

    A unique opportunity for journalists and cameramen to view Europe's next scientific satellite, XMM, will be provided at ESA/ESTEC, Noordwijk, the Netherlands on Tuesday 10 February at 10:00 a.m. On show will be the full-size development version of XMM which has completed engineering tests. Press representatives will be permitted to inspect it and take pictures at close quarters. Robert Lainé, the XMM project manager, and Fred Jansen, the XMM project scientist will present the spacecraft and mission. Roger Bonnet, Director of the ESA Science programme will present Horizons 2000, the future ESA Science programme. After the presentations they will be available to answer questions. Due for launch in 1999, XMM is an unprecedented space observatory for X-ray astronomy, with far greater sensitivity than any previous X-ray mission. It is also ESA's largest scientific spacecraft -- almost 11 metres long and with a mass of nearly 4 tonnes.

  20. Pediatric Cervicofacial Necrotizing Fasciitis

    PubMed Central

    King, Ericka; Chun, Robert; Sulman, Cecille

    2015-01-01

    Objective To present a case of a pediatric cervicofacial necrotizing fasciitis (NF), a rapidly progressive infection, and a review of a 10-year pediatric inpatient database. Design Case report and review. Setting Pediatric intensive care unit. Patients A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code 728.86 (NF), was the inclusion criteria for the Kids’ Inpatient Database (KID) in 1997 and 2006. Results A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from 1997 and 2006, the relative risk of being discharged with NF in 2006 vs 1997 was 1.4 (95% CI, 9.95-2.28). Age at diagnosis of NF was older in 2006 compared with 1997 (11.5 years vs 8.05 years; P<.001). Deaths with a diagnosis of NF increased from 1997 compared with 2006: from 3.9% to 5.4%. In 2006, the odds of death were 15.1 times higher in pediatric discharges with a diagnosis of NF compared with discharges without a diagnosis of NF (P<.001; 95% CI, 9.3-23.1). Conclusions Even with the advent of new treatments and antibiotics, the incidence and death rates of NF have changed little over the past 10 years. While it is still a rare diagnosis, knowledge and awareness of necrotizing fasciitis with aggressive medical and surgical treatment are still the foundation in disease survival. PMID:22508620

  1. Pediatric Emergency Research Networks: a global initiative in pediatric emergency medicine.

    PubMed

    Klassen, Terry P; Acworth, Jason; Bialy, Liza; Black, Karen; Chamberlain, James M; Cheng, Nicholas; Dalziel, Stuart; Fernandes, Ricardo M; Fitzpatrick, Eleanor; Johnson, David W; Kuppermann, Nathan; Macias, Charles G; Newton, Mandi; Osmond, Martin H; Plint, Amy; Valerio, Paolo; Waisman, Yehezkel

    2010-08-01

    The objectives of the Pediatric Emergency Research Network's (PERN) meeting were to (i) learn about each of the participating network's missions, goals, and infrastructure; (ii) share important contributions that each network has made to the creation of new knowledge; (iii) discuss 'best practices' to improve each network's effectiveness and (iv) explore the potential for a collaborative research project as proof-of-concept that would help promote quality of care of the acutely ill and injured child/youth globally. In October 2009 a multiday meeting was attended by 18 delegates representing the following pediatric emergency medicine research networks: Pediatric Emergency Medicine Collaborative Research Committee (USA); Pediatric Emergency Care Applied Research Network (USA); Pediatric Emergency Research of Canada (Canada); Pediatric Research in Emergency Departments International Collaborative (Australia and New Zealand); and Research in European Pediatric Emergency Medicine (15 countries in Europe and the Middle East). The inaugural meeting of PERN showed that there is a common desire for high-quality research and the dissemination of this research to improve health and outcomes of acutely ill and injured children and youths throughout the world. At present, the PERN group is in the final stages of developing a protocol to assess H1N1 risk factors with the collection of retrospective data. Several members of PERN will be gathering at the International Conference on Emergency Medicine in Singapore, where the group will be presenting information about the H1N1 initiative. The PERN group is planning to bring together all five networks later in 2010 to discuss future global collaborations.

  2. Neurocognitive functions in pediatric renal transplant patients.

    PubMed

    Gulleroglu, K; Baskin, E; Bayrakci, U S; Aydogan, M; Alehan, F; Kantar, A; Karakayali, F; Moray, G; Haberal, M

    2013-01-01

    Neurocognitive dysfunction is one of the major complications of chronic renal failure (CRF). Uremic state during CRF encompasses a wide spectrum of neurobehavioral and neurological disturbances. Recent studies showed that the pathophysiology of neurocognitive dysfunction in CRF is related to plasma levels of uremic solutes. Successful renal transplantation improves renal, metabolic, and endocrine functions and the quality of life. The aim of our study was to determine the state of neurocognitive function in pediatric renal transplant recipients. We prospectively performed a neurological examination and neuropsychological test battery (Bender-Gestalt Test, Cancellation Test, and Visual and Auditory Number Assay Test) in 20 pediatric renal transplant recipients between 6 and 16 years of age. Twenty healthy children and 20 children with CRF were included in the study as the control groups. Mean age of the renal transplant recipients was 13.50 ± 3.40 years old. Mean evaluation time after transplantation was 2.0 ± 0.5 years. Bender-Gestalt Test result was abnormal in 40% of patients. The results of the Cancellation Test and the Visual and Auditory Number Assay Test showed significant decline in pediatric renal transplant patients when compared with the control. We found that neurocognitive dysfunction was frequent in pediatric renal transplantation patients. Awareness of this potential problem may be helpful for early recognition and treatment. Our findings suggest that periodic neurocognitive assessments may be indicated in transplant recipients.

  3. Public medical shows.

    PubMed

    Walusinski, Olivier

    2014-01-01

    In the second half of the 19th century, Jean-Martin Charcot (1825-1893) became famous for the quality of his teaching and his innovative neurological discoveries, bringing many French and foreign students to Paris. A hunger for recognition, together with progressive and anticlerical ideals, led Charcot to invite writers, journalists, and politicians to his lessons, during which he presented the results of his work on hysteria. These events became public performances, for which physicians and patients were transformed into actors. Major newspapers ran accounts of these consultations, more like theatrical shows in some respects. The resultant enthusiasm prompted other physicians in Paris and throughout France to try and imitate them. We will compare the form and substance of Charcot's lessons with those given by Jules-Bernard Luys (1828-1897), Victor Dumontpallier (1826-1899), Ambroise-Auguste Liébault (1823-1904), Hippolyte Bernheim (1840-1919), Joseph Grasset (1849-1918), and Albert Pitres (1848-1928). We will also note their impact on contemporary cinema and theatre.

  4. The Great Cometary Show

    NASA Astrophysics Data System (ADS)

    2007-01-01

    its high spatial and spectral resolution, it was possible to zoom into the very heart of this very massive star. In this innermost region, the observations are dominated by the extremely dense stellar wind that totally obscures the underlying central star. The AMBER observations show that this dense stellar wind is not spherically symmetric, but exhibits a clearly elongated structure. Overall, the AMBER observations confirm that the extremely high mass loss of Eta Carinae's massive central star is non-spherical and much stronger along the poles than in the equatorial plane. This is in agreement with theoretical models that predict such an enhanced polar mass-loss in the case of rapidly rotating stars. ESO PR Photo 06c/07 ESO PR Photo 06c/07 RS Ophiuchi in Outburst Several papers from this special feature focus on the later stages in a star's life. One looks at the binary system Gamma 2 Velorum, which contains the closest example of a star known as a Wolf-Rayet. A single AMBER observation allowed the astronomers to separate the spectra of the two components, offering new insights in the modeling of Wolf-Rayet stars, but made it also possible to measure the separation between the two stars. This led to a new determination of the distance of the system, showing that previous estimates were incorrect. The observations also revealed information on the region where the winds from the two stars collide. The famous binary system RS Ophiuchi, an example of a recurrent nova, was observed just 5 days after it was discovered to be in outburst on 12 February 2006, an event that has been expected for 21 years. AMBER was able to detect the extension of the expanding nova emission. These observations show a complex geometry and kinematics, far from the simple interpretation of a spherical fireball in extension. AMBER has detected a high velocity jet probably perpendicular to the orbital plane of the binary system, and allowed a precise and careful study of the wind and the shockwave

  5. Pediatric brain death: updated guidelines.

    PubMed

    Mullen, Jodi E

    2013-01-01

    Logan, a 5-year-old boy, was riding his bike with his 7-year-old brother when he was struck from behind by a car traveling at approximately 40 mph. The driver indicated that she did not see the riders until she hit Logan, who was not wearing a helmet at the time of the accident. Logan was thrown from his bike and was found at the side of the road, unresponsive and posturing. Although he was uninjured, Logan's brother witnessed the incident.Emergency medical services arrived and placed Logan on a backboard with a c-collar. Because he was not protecting his airway, he was intubated and then given sodium chloride fluids and brought to the pediatric emergency department. Upon arrival, his Glasgow Coma Scale score was 5, and his right pupil was 6 mm and not reactive.Logan's initial head computed tomographic scan showed diffuse brain edema, with early downward transtentorial brain herniation. The pediatric neurosurgeon determined that no operative management was appropriate for Logan. Besides a small laceration on his forehead, Logan had no other injuries. At this time, he was taking a few spontaneous respirations and had occasional posturing of his extremities.

  6. The pediatric vaccine stockpiling problem.

    PubMed

    Truong, Van-Anh

    2012-09-21

    The U.S. has experienced many major interruptions of its pediatric vaccine production in the past decade. The Centers for Disease Control and Prevention (CDC) copes with these shortages by building a national stockpile of pediatric vaccines, which it makes accessible to the public in the event of a shortage. The management of this stockpile is difficult due to limited production capacity and long and unpredictable production interruptions. In this paper, we address policies for managing the stockpile. We provide sufficient conditions for the optimal policy to be a modified state-dependent base-stock policy, with the base-stock level decreasing in the pipeline inventory. Since the optimal policy is in general difficult to evaluate, we derive bounds on the optimal decision in each period. We develop an efficient policy that performs on average within 1% of optimality in simulations. We show that stocking the same supply of vaccine of every type can be over-conservative in some cases, and inadequate in others by large factors. We also quantify the substantial reduction in inventory level that can be achieved when there are multiple suppliers in the market. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. [Management of pediatric status epilepticus].

    PubMed

    Vargas L, Carmen Paz; Varela E, Ximena; Kleinsteuber S, Karin; Cortés Z, Rocío; Avaria B, María de Los Ángeles

    2016-01-01

    Pediatric Status Epilepticus (SE) is an emergency situation with high morbidity and mortality that requires early and aggressive management. The minimum time criterion to define SE was reduced from 30 to 5 minutes, defined as continuous seizure activity or rapidly recurrent seizures without resumption of consciousness for more than 5 minutes. This definition considers that seizures that persist for > 5 minutes are likely to do so for more than 30 min. Those that persist for more than 30 minutes are more difficult to treat. Refractory SE is the condition that extends beyond 60-120 minutes and requires anesthetic management. Super-refractory SE is the state of no response to anesthetic management or relapse during withdrawal of these drugs. The aim of this review is to provide and update on convulsive SE concepts, pathophysiology, etiology, available antiepileptic treatment and propose a rational management scheme. A literature search of articles published between January 1993 and January 2013, focused on pediatric population was performed. The evidence about management in children is limited, mostly corresponds to case series of patients grouped by diagnosis, mainly adults. These publications show treatment alternatives such as immunotherapy, ketogenic diet, surgery and hypothermia. A 35% mortality, 26% of neurological sequelae and 35% of recovery to baseline condition is described on patient’s evolution.

  8. Quality improvement in pediatric sepsis.

    PubMed

    Melendez, Elliot; Bachur, Richard

    2015-06-01

    Although there is abundant literature detailing the impact of quality improvement in adult sepsis, the pediatric literature is lacking. Despite consensus definitions for sepsis, which patients along the sepsis spectrum should receive aggressive management and the exact onset of sepsis ('time zero') are not clearly established. In the adult emergency department (ED), sepsis onset is defined as the time of entry into the ED; however, this definition cannot be applied to hospitalized patients or patients who evolve during their ED course. Since the time of sepsis onset will dictate the timeliness of subsequent process measures, the variable definitions in the literature make it difficult to generalize findings among prior studies. Despite the variation in defining time zero, aggressive fluid administration, timely antibiotics, and compliance with sepsis bundles have been shown to improve mortality and to reduce hospital and intensive care length of stay. In addition, early identification tools show promise in beginning to define sepsis onset and retrospective search tools may allow improved case finding of those children of concern for sepsis. Quality improvement in pediatric sepsis is evolving. As we continue to define quality measures, we must standardize the definition of sepsis onset. This definition should be applicable to any treatment venue to ensure measures can be evaluated across all settings. In addition, we must delineate which patients along the sepsis spectrum should be candidates for timely interventions and standardize other outcome measures beyond mortality.

  9. Let's go to camp! An innovative pediatric practice placement.

    PubMed

    Schick Makaroff, Kara; Scobie, Robin; Williams, Cheryl; Kidd, Janeen

    2013-01-01

    Each year, children living with disabilities escape from their families for 1 week at camp armed with their sun block, sleeping bags and talent-show costumes. In British Columbia, Canada, Easter Seals Camps offer such adventures to over 800 children/teens with physical/mental disabilities, providing free, overnight camping with on-site nurses. Easter Seals Camps offer pediatric placements to nursing students to work with nurses in a multidisciplinary team. In this paper, we describe this partnership, explain the role of camp nurse, portray student learning opportunities and offer recommendations to pediatric nurses who may consider participating in similar innovative placements in pediatric camps.

  10. Factors associated with ability to treat pediatric emergencies in US hospitals.

    PubMed

    Burt, Catharine W; Middleton, Kimberly R

    2007-10-01

    The purpose of this analysis is to investigate hospital and community factors associated with the availability of pediatric services, expertise, and supplies in US hospitals for treating pediatric emergencies. Data from the Emergency Pediatric Services and Equipment Supplement, a component of the 2002-2003 National Hospital Ambulatory Medical Care Survey, were merged with hospital and community characteristics to model preparedness to treat pediatric emergencies. The National Hospital Ambulatory Medical Care Survey samples nonfederal, short-stay, and general hospitals in the United States. The Emergency Pediatric Services and Equipment Supplement was based on the 2001 guidelines developed by the American Academy of Pediatrics and the American College of Emergency Physicians. Estimates were weighted to produce unbiased national estimates of pediatric services, expertise, and equipment availability in emergency departments. Logistic regression was used to model the probability of being better prepared based on the above guidelines. Bivariate analyses showed that hospital inpatient pediatric structure was linearly related to availability of supplies. However, inpatient structure was not associated with presence of a pediatric trauma service or written transfer agreement. Logistic regressions with each preparedness measure indicated that, after adjusting for hospital and community factors, pediatric volume, teaching hospital status, geographic region, and per capita income of the community were strongly related to being better prepared on each of the preparedness measures. To meet the 2001 guidelines, emergency departments need to improve their inventory of pediatric supplies, and hospitals that do not have specialized inpatient services need to implement written transfer agreements with other hospitals.

  11. Stretched View Showing 'Victoria'

    NASA Technical Reports Server (NTRS)

    2006-01-01

    [figure removed for brevity, see original site] Stretched View Showing 'Victoria'

    This pair of images from the panoramic camera on NASA's Mars Exploration Rover Opportunity served as initial confirmation that the two-year-old rover is within sight of 'Victoria Crater,' which it has been approaching for more than a year. Engineers on the rover team were unsure whether Opportunity would make it as far as Victoria, but scientists hoped for the chance to study such a large crater with their roving geologist. Victoria Crater is 800 meters (nearly half a mile) in diameter, about six times wider than 'Endurance Crater,' where Opportunity spent several months in 2004 examining rock layers affected by ancient water.

    When scientists using orbital data calculated that they should be able to detect Victoria's rim in rover images, they scrutinized frames taken in the direction of the crater by the panoramic camera. To positively characterize the subtle horizon profile of the crater and some of the features leading up to it, researchers created a vertically-stretched image (top) from a mosaic of regular frames from the panoramic camera (bottom), taken on Opportunity's 804th Martian day (April 29, 2006).

    The stretched image makes mild nearby dunes look like more threatening peaks, but that is only a result of the exaggerated vertical dimension. This vertical stretch technique was first applied to Viking Lander 2 panoramas by Philip Stooke, of the University of Western Ontario, Canada, to help locate the lander with respect to orbiter images. Vertically stretching the image allows features to be more readily identified by the Mars Exploration Rover science team.

    The bright white dot near the horizon to the right of center (barely visible without labeling or zoom-in) is thought to be a light-toned outcrop on the far wall of the crater, suggesting that the rover can see over the low rim of Victoria. In figure 1, the northeast and southeast rims are labeled

  12. Stretched View Showing 'Victoria'

    NASA Technical Reports Server (NTRS)

    2006-01-01

    [figure removed for brevity, see original site] Stretched View Showing 'Victoria'

    This pair of images from the panoramic camera on NASA's Mars Exploration Rover Opportunity served as initial confirmation that the two-year-old rover is within sight of 'Victoria Crater,' which it has been approaching for more than a year. Engineers on the rover team were unsure whether Opportunity would make it as far as Victoria, but scientists hoped for the chance to study such a large crater with their roving geologist. Victoria Crater is 800 meters (nearly half a mile) in diameter, about six times wider than 'Endurance Crater,' where Opportunity spent several months in 2004 examining rock layers affected by ancient water.

    When scientists using orbital data calculated that they should be able to detect Victoria's rim in rover images, they scrutinized frames taken in the direction of the crater by the panoramic camera. To positively characterize the subtle horizon profile of the crater and some of the features leading up to it, researchers created a vertically-stretched image (top) from a mosaic of regular frames from the panoramic camera (bottom), taken on Opportunity's 804th Martian day (April 29, 2006).

    The stretched image makes mild nearby dunes look like more threatening peaks, but that is only a result of the exaggerated vertical dimension. This vertical stretch technique was first applied to Viking Lander 2 panoramas by Philip Stooke, of the University of Western Ontario, Canada, to help locate the lander with respect to orbiter images. Vertically stretching the image allows features to be more readily identified by the Mars Exploration Rover science team.

    The bright white dot near the horizon to the right of center (barely visible without labeling or zoom-in) is thought to be a light-toned outcrop on the far wall of the crater, suggesting that the rover can see over the low rim of Victoria. In figure 1, the northeast and southeast rims are labeled

  13. LEED I/V determination of the structure of a MoO3 monolayer on Au(111): Testing the performance of the CMA-ES evolutionary strategy algorithm, differential evolution, a genetic algorithm and tensor LEED based structural optimization

    NASA Astrophysics Data System (ADS)

    Primorac, E.; Kuhlenbeck, H.; Freund, H.-J.

    2016-07-01

    The structure of a thin MoO3 layer on Au(111) with a c(4 × 2) superstructure was studied with LEED I/V analysis. As proposed previously (Quek et al., Surf. Sci. 577 (2005) L71), the atomic structure of the layer is similar to that of a MoO3 single layer as found in regular α-MoO3. The layer on Au(111) has a glide plane parallel to the short unit vector of the c(4 × 2) unit cell and the molybdenum atoms are bridge-bonded to two surface gold atoms with the structure of the gold surface being slightly distorted. The structural refinement of the structure was performed with the CMA-ES evolutionary strategy algorithm which could reach a Pendry R-factor of ∼ 0.044. In the second part the performance of CMA-ES is compared with that of the differential evolution method, a genetic algorithm and the Powell optimization algorithm employing I/V curves calculated with tensor LEED.

  14. [Kingella kingae pediatric septic arthritis].

    PubMed

    Vásquez, María Alejandra; Palacián, María Pilar; Cruz Villuendas, María; Marne, Carmen; Paz Ruiz-Echarri, María; Revillo, María José

    2012-12-01

    Kingella kingae is a bacterium that colonizes the upper respiratory tract. Despite its low pathogenicity in this location, previous respiratory pathological processes may favor its systemic spread causing bone and joint infections, mainly in children under five years. It can be considered an emerging pathogen in osteoarticular infection in pediatric patients. We report the case of a two-year-old girl with hips pain and limitation of both abduction and extension, and fever. Radiography and ultrasonography were compatible with transitory synovitis; showed scintigraphy inflammatory pathology of the right hip. Articular puncture was performed. The material showed altered biochemical parameters. Microbiological culture yielded isolation of a strain of K. kingae susceptible to beta-lactam antibiotics, azithromycin and trimethoprim-sulfamethoxazole. Blood cultures were negative. The patient was treated empirically with cloxacillin and cefotaxime iv. and continued with amoxicillin-clavulanate orally with osteoarticular improvement.

  15. The history of pediatric surgery in France.

    PubMed

    Prévot, J

    1986-01-01

    In 1741, Nicolas Andry, counsellor of King Louis XV, published a book about "orthopedics," inventing this word. The book is interesting as the author refers to beliefs and habits of the time. In 1864, Guersant published Notes About Pediatric Surgery, a real textbook which was translated into English and German and dealt with the importance of children's psychological training, anesthesia, and water or mother's milk after the operation, and also described tracheotomy, draining of cervical adenitis, and lithotrity. The classification of bone affections was still very confused. Tuberculosis and syphilis have an important place; hypospadias is not treated by surgery. In 1905, Froehlich published Pediatric Surgery Studies dealing exclusively with visceral surgery and demonstrating progress compared to Guersant's study. In 1906, Kirmisson published Pediatric Surgical Textbook, containing the first discussion of radiology and the description of the pathology of the omphalomesenteric duct and of other congenital malformations. Osteomyelitis was given its proper name, and cervical fistulas were explained. In 1914, A. Broca achieved further progress describing treatments of megacolon, intussusception, and the operation of Fredet Ramstedt. The book by Ombredanne, already out of date at the time of its publication, showed that he was not aware of the wartime, progress achieved by Ladd and Gross in the USA. French publications have diminished since then, and French pediatric surgery is still trying to find a precise identity.

  16. Therapy of highly active pediatric multiple sclerosis.

    PubMed

    Huppke, Peter; Huppke, Brenda; Ellenberger, David; Rostasy, Kevin; Hummel, Hannah; Stark, Wiebke; Brück, Wolfgang; Gärtner, Jutta

    2017-09-01

    Study aims were to determine the frequency of highly active disease in pediatric multiple sclerosis (MS), the response to natalizumab (NTZ) and fingolimod (FTY) treatment, and the impact of current treatment modalities on the clinical course. Retrospective single-center study in the German Center for MS in Childhood and Adolescence. Of 144 patients with first MS manifestation between 2011 and 2015, 41.6% fulfilled the criteria for highly active MS. In total, 55 patients treated with NTZ and 23 with FTY demonstrated a significant reduction in relapse rate (NTZ: 95.2%, FTY: 75%), new T2 lesions (NTZ: 97%, FTY: 81%), and contrast-enhancing lesions (NTZ: 97%, FTY: 93%). However, seven patients switched from NTZ to FTY experienced an increase in disease activity. Comparing pediatric MS patients treated in 2005 with those treated in 2015 showed a 46% reduction in relapse rate and a 44% reduction in mean Expanded Disability Status Scale (EDSS). The rate of highly active disease among pediatric MS patients is high; more than 40% in our cohort. Response to NTZ and FTY treatment is similar if not better than observed in adults. Current treatment modalities including earlier treatment initiation and the introduction of NTZ and FTY have significantly improved the clinical course of pediatric MS.

  17. Emergency Medical Service Personnel Recognize Pediatric Concussions

    PubMed Central

    Speirs, Joshua N.; Lyons, Matthew I.; Johansson, Bert E.

    2017-01-01

    Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed. This first of its kind pilot study was designed to assess EMS personnel’s ability to recognize and triage pediatric concussions. Our findings show EMS providers are statistically identical in their ability to recognize and triage concussions to physicians. The performance of our MD participants was lower than expected. Larger studies are needed to further investigate EMS providers’ ability to recognize a concussion. PMID:28812053

  18. Pediatric robotic urologic surgery-2014.

    PubMed

    Kearns, James T; Gundeti, Mohan S

    2014-07-01

    We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide.

  19. Pediatric robotic urologic surgery-2014

    PubMed Central

    Kearns, James T.; Gundeti, Mohan S.

    2014-01-01

    We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide. PMID:25197187

  20. An update on pediatric endoscopy.

    PubMed

    Friedt, Michael; Welsch, Simon

    2013-07-25

    Advances in endoscopy and anesthesia have enabled gastrointestinal endoscopy for children since 1960. Over the past decades, the number of endoscopies has increased rapidly. As specialized teams of pediatric gastroenterologists, pediatric intensive care physicians and pediatric endoscopy nurses are available in many medical centers, safe and effective procedures have been established. Therefore, diagnostic endoscopies in children are routine clinical procedures. The most frequently performed endoscopies are esophagogastroduodenoscopy (EGD), colonoscopy and endoscopic retrograde cholangiopancreaticography (ERCP). Therapeutic interventions include variceal bleeding ligation, foreign body retrieval and percutaneous endoscopic gastrostomy. New advances in pediatric endoscopy have led to more sensitive diagnostics of common pediatric gastrointestinal disorders, such as Crohn's disease, ulcerative colitis and celiac disease; likewise, new diseases, such as eosinophilic esophagitis, have been brought to light.Upcoming modalities, such as capsule endoscopy, double balloon enteroscopy and narrow band imaging, are being established and may contribute to diagnostics in pediatric gastroenterology in the future.

  1. What Is a Pediatric Critical Care Specialist?

    MedlinePlus

    ... Email Print Share What is a Pediatric Critical Care Specialist? Page Content Article Body If your child ... PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care specialists are medical ...

  2. What Is a Pediatric Infectious Diseases Specialist?

    MedlinePlus

    ... Size Email Print Share What is a Pediatric Infectious Diseases Specialist? Page Content Article Body If your child ... teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases specialists are medical ...

  3. Acupuncture for Pediatric Pain

    PubMed Central

    Golianu, Brenda; Yeh, Ann Ming; Brooks, Meredith

    2014-01-01

    Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed. PMID:27417472

  4. Hippocrates on Pediatric Dermatology.

    PubMed

    Sgantzos, Markos; Tsoucalas, Gregory; Karamanou, Marianna; Giatsiou, Styliani; Tsoukalas, Ioannis; Androutsos, George

    2015-01-01

    Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia.

  5. Recurrent Pediatric Perianal Swelling.

    PubMed

    Cordova, Jonathan; Chugh, Ankur; Rivera Rivera, Edgardo D; Young, Sona

    2016-02-01

    Pediatric inflammatory bowel disease is a chronic gastrointestinal disease consisting of Crohn's disease (CD) and ulcerative colitis (UC). Both disease processes can share similar clinical symptoms including abdominal pain, diarrhea, hematochezia, and weight loss; CD can also be complicated by penetrating and fistulizing disease. Perianal skin tags, perianal abscesses, recto-cutaneous fistulae, and rectal stenosis are among the phenotypic characteristics of perianal CD. Current treatment strategies are focused on the surgical drainage of abscesses and the closure of fistulous tracts as well as controlling intestinal inflammation with the use of immunomodulators (6-mercaptopurine and methotrexate) and biologics (infliximab and adalimumab). Current guidelines by the American Gastroenterology Association and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend a combination of surgical intervention and medical management for the treatment of perianal CD.

  6. Pediatric Stroke: A Review

    PubMed Central

    Tsze, Daniel S.; Valente, Jonathan H.

    2011-01-01

    Stroke is relatively rare in children, but can lead to significant morbidity and mortality. Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children. Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under- or misdiagnosed. Clinical presentation will vary based on the child's age, and children will have risk factors for stroke that are less common than in adults. Management strategies in children are extrapolated primarily from adult studies, but with different considerations regarding short-term anticoagulation and guarded recommendations regarding thrombolytics. Although most recommendations for management are extrapolated from adult populations, they still remain useful, in conjunction with pediatric-specific considerations. PMID:22254140

  7. Pediatric Palatal Fibroma

    PubMed Central

    Khan, Tayyeb S; Ajaz, Tarannum; Agarwal, Mamta

    2017-01-01

    Fibroma is one of the most common soft tissue benign tumors of the oral cavity. These masses represent hyperplasias instead of true neoplasm, which develop due to irritation to the mucosal tissue resulting in proliferation of the cells. Although so common in the oral cavity, its occurrence on the palate is rare, mainly due to fewer chances of trauma. Here, we report a case of palatal fibroma in a child diagnosed on the basis of clinical, radiological, and histological features. The case represents an extremely rare occurrence as unusual trauma due to thumb sucking seemed to be the only apparent traumatic factor in the palatal region. How to cite this article Mishra R, Khan TS, Ajaz T, Agarwal M. Pediatric Palatal Fibroma. Int J Clin Pediatr Dent 2017; 10(1):96-98. PMID:28377663

  8. Pediatric obesity. An introduction.

    PubMed

    Yanovski, Jack A

    2015-10-01

    The prevalence of child and adolescent obesity in the United States increased dramatically between 1970 and 2000, and there are few indications that the rates of childhood obesity are decreasing. Obesity is associated with myriad medical, psychological, and neurocognitive abnormalities that impact children's health and quality of life. Genotypic variation is important in determining the susceptibility of individual children to undue gains in adiposity; however, the rapid increase in pediatric obesity prevalence suggests that changes to children's environments and/or to their learned behaviors may dramatically affect body weight regulation. This paper presents an overview of the epidemiology, consequences, and etiopathogenesis of pediatric obesity, serving as a general introduction to the subsequent papers in this Special Issue that address aspects of childhood obesity and cognition in detail.

  9. [Pediatric adamantinoma. Case report].

    PubMed

    Cafferata, Constanza; Galluzzo, Laura; Cacciavillano, Walter; Innocenti, Sergio

    2015-01-01

    Adamantinoma is a primary tumor of long bones, which affects mainly the shaft of the tibia, and is extremely rare in pediatrics. It frequently presents during the second decade of life, with a slight predominance in males. It is a low grade tumor, with local aggressiveness and low rate of metastasis and recurrence once it is completely removed. Its diagnosis is difficult, not only because it is a rare disease in children, but also because of the difficulty in the differential diagnosis with other benign lesions. We report the case of a 15-year-old patient with a painless swelling of the distal tibia, whose diagnosis was confirmed with the piece of amputation, as imaging features and both initial biopsies were not enough to achieve diagnosis. Though most of the literature consists of case reports, and very few in pediatric patients, they all agree on the difficulty in achieving the diagnosis of adamantinoma.

  10. Online resources in pediatrics

    PubMed Central

    Goldman, Ran D.

    2014-01-01

    Abstract Question In the past few years, parents of children seen in my clinic are frequently conducting online searches relating to medical questions. How reliable are online resources in pediatrics and what guidance can I provide parents when searching online about their children’s health? Answer The use of the Internet to gather medical information has increased dramatically over the past decade, including in the field of pediatrics. The enormous amount of information is confusing to parents and providers alike, and general search engines have not done enough to distinguish reliable from biased information. Physicians can develop websites with reliable content, advise parents on how to identify reliable sources of information, and give examples of websites to review child health–related topics. PMID:24829005

  11. Pediatric head injury.

    PubMed

    Tulipan, N

    1998-01-01

    Pediatric head injury is a public health problem that exacts a high price from patients, their families and society alike. While much of the brain damage in head-injured patients occurs at the moment of impact, secondary injuries can be prevented by aggressive medical and surgical intervention. Modern imaging devices have simplified the task of diagnosing intracranial injuries. Recent advances in monitoring technology have made it easier to assess the effectiveness of medical therapy. These include intracranial pressure monitoring devices that are accurate and safe, and jugular bulb monitoring which provides a continuous, qualitative measure of cerebral blood flow. The cornerstones of treatment remain hyperventilation and osmotherapy. Despite maximal treatment, however, the mortality and morbidity associated with pediatric head injury remains high. Reduction of this mortality and morbidity will likely depend upon prevention rather than treatment.

  12. Ethics, genetics and pediatrics.

    PubMed

    Souza, Ricardo Timm de; Goldim, José Roberto

    2008-08-01

    To reflect on the nature of ethics, from a contemporary perspective, and also on which features of the family relationship have an impact on the interface between genetics and pediatrics. The data used are the fruit of the authors' own intellectual production plus other bibliographic references. Genetics has presented ethics with new challenges. Particularly in pediatrics, where caring for patients is almost indivisible from a continuous relationship with their families, these issues are amplified even further, generating new questions that health professionals have not previously had to face. Based on the reflections outlined here, emphasis can be placed on the importance of actively recognizing the Other in its multiple dimensions and on the repercussions that this perspective has for the physician-patient-family relationship.

  13. Pediatric nail diseases: clinical pearls.

    PubMed

    Oberlin, Kate E

    2017-02-01

    This article highlights pearls shared during a unique and enlightening lecture by Antonella Tosti, MD, a professor at the University of Miami Health System, Florida, on the presentation and management of common pediatric nail diseases. These clinical pearls are shared to help deliver utmost care to our pediatric patients presenting with nail pathology and may help shed light on the management of pediatric nail diseases.

  14. Benign Pediatric Salivary Gland Lesions.

    PubMed

    Carlson, Eric R; Ord, Robert A

    2016-02-01

    Salivary gland lesions are rare in pediatric patients. In addition, the types of salivary gland tumors are different in their distribution in specific sites in the major and minor salivary glands in children compared with adults. This article reviews benign neoplastic and nonneoplastic salivary gland disorders in pediatric patients to help clinicians to develop an orderly differential diagnosis that will lead to expedient treatment of pediatric patients with salivary gland lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Managing the Pediatric Facial Fracture

    PubMed Central

    Cole, Patrick; Kaufman, Yoav; Hollier, Larry H.

    2009-01-01

    Facial fracture management is often complex and demanding, particularly within the pediatric population. Although facial fractures in this group are uncommon relative to their incidence in adult counterparts, a thorough understanding of issues relevant to pediatric facial fracture management is critical to optimal long-term success. Here, we discuss several issues germane to pediatric facial fractures and review significant factors in their evaluation, diagnosis, and management. PMID:22110800

  16. Pacific Pediatric Advanced Care Initiative

    DTIC Science & Technology

    2011-01-01

    Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study. Pediatr Rehabil...et al: Cerebral saturations trend with mixed venous saturations in patients undergoing extracorporeal life support. Perfusion. 2004 May;19(3):171-6...Seidel K, et al: Cerebral oxygenation in neonatal and pediatric patients during veno-arterial extracorporeal life support. Pediatr Crit Care Med

  17. MR in pediatric neuroimaging

    SciTech Connect

    Wolpert, S.M. ); Barnes, P.; Strand, R. )

    1990-01-01

    The multitude of modern imaging techniques has made pediatric neuroradiology increasingly complex. The practitioner must have a thorough understanding of each possible diagnostic study in order to achieve the best results at the least expense and with minimal risk. In this book, MRI is emphasized; correlative CT, ultrasound, angiographic, and conventional x-ray studies assist in establishing effective diagnostic protocols and reaching accurate diagnoses.

  18. Pediatric Bipolar Disorder

    PubMed Central

    Aravind, V. K.; Krishnaram, V. D.

    2009-01-01

    Clinicians are less sensitive in considering the diagnosis of mania in children because of the variations in clinical presentation and because of the high comorbidity with other psychiatric disorders. More often than the elated and expansive mood, irritability and significant aggression may be the presenting symptoms in these cases. One such case report is discussed highlighting the clinical aspects of pediatric bipolar disorder. PMID:21938101

  19. Critical pediatric equipment availability in Canadian hospital emergency departments.

    PubMed

    McGillivray, D; Nijssen-Jordan, C; Kramer, M S; Yang, H; Platt, R

    2001-04-01

    Of all child visits to emergency departments, 1% to 5% involve critically ill children who require cardiopulmonary resuscitation. Numerous versions of pediatric equipment lists for EDs have been published. Despite these efforts, many EDs remain unprepared for pediatric emergencies. The objectives of this study were to assess the availability of pediatric resuscitation equipment items in Canadian hospital EDs and to identify risk factors for the unavailability of these items. Using the updated database of the Canadian Association of Emergency Physicians (CAEP), a questionnaire survey was sent to 737 Canadian hospital EDs with a maximum of 3 mailings to nonresponders. On-site visits to a selected subset of hospital EDs were completed to validate the results obtained by the mailed questionnaire. The response rate was 88.3% (650/737). Results showed the following overall equipment unavailability: intraosseous needle, 15.9%; pediatric drug dose guidelines, 6.6%; infant blood pressure cuff, 14.8%; pediatric defibrillator paddles, 10.5%; infant warming device, 59.4%; infant bag-valve-mask device, 3.5%; infant laryngoscope blade, 3.5%; 3-mm endotracheal tube, 2.5%; and pediatric pulse oximeter, 18.0%. Low percentage of pediatric visits, lack of an on-call pediatrician for the ED, and lack of a pediatric advanced life support-trained physician on staff were independently associated with equipment unavailability. This study demonstrated that essential pediatric resuscitation equipment is unavailable in a disturbingly high number of EDs across Canada and has identified several determinants of this unavailability.

  20. Serum tumor markers in pediatric osteosarcoma: a summary review

    PubMed Central

    2012-01-01

    Osteosarcoma is the most common primary high-grade bone tumor in both adolescents and children. Early tumor detection is key to ensuring effective treatment. Serum marker discovery and validation for pediatric osteosarcoma has accelerated in recent years, coincident with an evolving understanding of molecules and their complex interactions, and the compelling need for improved pediatric osteosarcoma outcome measures in clinical trials. This review gives a short overview of serological markers for pediatric osteosarcoma, and highlights advances in pediatric osteosarcoma-related marker research within the past year. Studies in the past year involving serum markers in patients with pediatric osteosarcoma can be assigned to one of four categories, i.e., new approaches and new markers, exploratory studies in specialized disease subsets, large cross-sectional validation studies, and longitudinal studies, with and without an intervention. Most of the studies have examined the association of a serum marker with some aspect of the natural history of pediatric osteosarcoma. As illustrated by the many studies reviewed, several serum markers are emerging that show a credible association with disease modification. The expanding pool of informative osteosarcoma-related markers is expected to impact development of therapeutics for pediatric osteosarcoma positively and, it is hoped, ultimately clinical care. Combinations of serum markers of natural immunity, thyroid hormone homeostasis, and bone tumorigenesis may be undertaken together in patients with pediatric osteosarcoma. These serum markers in combination may do better. The potential effect of an intrinsic dynamic balance of tumor angiogenesis residing within a single hormone (tri-iodothyronine) is an attractive concept for regulation of vascularization in pediatric osteosarcoma. PMID:22587902

  1. Knowledge and attitudes regarding pediatric pain in Mongolian nurses.

    PubMed

    Lunsford, Lisa

    2015-06-01

    The World Health Organization and the International Association for Study of Pain cite the significance of pediatric pain as a significant global health issue. Developing countries may have increased needs compared with developed countries because of limited resources and lack of training. In Mongolia a paucity of data exist regarding nursing knowledge of pediatric pain management. The purpose of this project was to assess the current knowledge of pediatric pain and to assess the effectiveness of educational intervention on improving knowledge and attitudes of pediatric nurses working at a major children's hospital in Mongolia. Knowledge and attitudes of Mongolian nurses were evaluated before and after a 2-hour educational intervention. The translated Modified Mongolian Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain-Shriner's Revision survey was used as a pre- and postintervention assessment instrument with local nurses at a pediatric hospital in Ulaanbaatar, Mongolia. One hundred sixty-seven nurses attended the conference, with 155 nurses completing the pre- and postsurveys. The mean score on the presurvey was 12.7 out of 35 (26.4% correct), whereas the mean score on the postsurvey score was 16.7 out of 35 (47.8% correct). A paired t test showed a significant statistical difference between scores (p < .0001). Pediatric nurses in Mongolia demonstrate insufficient knowledge of pediatric pain management. The educational intervention was effective in improving pediatric pain knowledge and attitudes in Mongolian nurses. It is recommended to establish similar educational endeavors with nurses around the world to improve pain knowledge and attitudes. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  2. Nutritional assessment in pediatrics.

    PubMed

    Mascarenhas, M R; Zemel, B; Stallings, V A

    1998-01-01

    Nutritional status affects every pediatric patient's response to illness. Good nutrition is important for achieving normal growth and development. Nutritional assessment therefore should be an integral part of the care for every pediatric patient. Routine screening measures for abnormalities of growth should be performed on all pediatric patients. Those patients with chronic illness and those at risk for malnutrition should have detailed nutritional assessments done. Components of a complete nutritional assessment include a medical history, nutritional history including dietary intake, physical examination, anthropometrics (weight, length or stature, head circumference, midarm circumference, and triceps skinfold thickness), pubertal staging, skeletal maturity staging, and biochemical tests of nutritional status. Alternative measures for linear growth assessment (e.g., lower leg and upper arm measures) can be performed on patients unable to stand or who have musculoskeletal deformities. Bone densitometry can be used to assess bone mineralization and the risk of fracture. Nutritionally at risk patients may benefit from determination of resting energy expenditure by indirect calorimetry. The use of age, gender, and disease-specific growth charts is essential in assessing nutritional status and monitoring nutrition interventions. The importance of accurate measurements using trained personnel and appropriate equipment cannot be overemphasized.

  3. Nutrition in Pediatric Cardiomyopathy

    PubMed Central

    Miller, Tracie L.; Neri, Daniela; Extein, Jason; Somarriba, Gabriel; Strickman-Stein, Nancy

    2007-01-01

    Pediatric cardiomyopathies are heterogeneous groups of serious disorders of the heart muscle and are responsible for significant morbidity and mortality among children who have the disease. While enormous improvements have been made in the treatment and survival of children with congenital heart disease, parallel strides have not been made in the outcomes for cardiomyopathies. Thus, ancillary therapies, such as nutrition and nutritional interventions, that may not cure but may potentially improve cardiac function and quality of life, are imperative to consider in children with all types of cardiomyopathy. Growth failure is one of the most significant clinical problems of children with cardiomyopathy with nearly one-third of children with this disorder manifesting some degree of growth failure during the course of their illness. Optimal intake of macronutrients can help improve cardiac function. In addition, several specific nutrients have been shown to correct myocardial abnormalities that often occur with cardiomyopathy and heart failure. In particular, antioxidants that can protect against free radical damage that often occurs in heart failure and nutrients that augment myocardial energy production are important therapies that have been explored more in adults with cardiomyopathy than in the pediatric population. Future research directions should pay particular attention to the effect of overall nutrition and specific nutritional therapies on clinical outcomes and quality of life in children with pediatric cardiomyopathy. PMID:18159216

  4. Obesity in pediatric trauma.

    PubMed

    Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P

    2017-04-01

    The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values <0.001). On multivariable analysis, higher BMI percentiles were associated with significantly increased likelihood of death, deep venous thrombosis, pulmonary embolus and pneumonia; although there was no difference in risk of overall complications. Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Issues in Pediatric Craniofacial Trauma.

    PubMed

    Chandra, Srinivasa R; Zemplenyi, Karen S

    2017-11-01

    Pediatric maxillofacial fractures are rare owing to anatomic differences between juvenile and adult skulls. Children's bone is less calcified, allowing for "greenstick fractures." The overall ratio of cranial to facial volume decreases with age. In children, tooth buds comprise the majority of mandibular volume. The most common pediatric craniomaxillofacial fractures for children ages 0 to 18 years old are mandible, nasal bone, and maxilla and zygoma. Growth potential must be considered when addressing pediatric trauma and often a less-is-more approach is best when considering open versus closed treatment. Regardless of treatment, pediatric trauma cases must be followed through skeletal maturity. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Moral Dilemmas in Pediatric Orthopedics.

    PubMed

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result.

  7. Application of the Pediatric Risk of Mortality Score (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit

    PubMed Central

    de Araujo Costa, Graziela; Delgado, Artur F; Ferraro, Alexandre; Okay, Thelma Suely

    2010-01-01

    INTRODUCTION: To establish disease severity at admission can be performed by way of the mortality prognostic. Nowadays the prognostic scores make part of quality control and research. The Pediatric Risk of Mortality (PRISM) is one of the scores used in the pediatric intensive care units. OBJECTIVES: The purpose of this study is the utilization of the PRISM and determination of mortality risk factors in a tertiary pediatric intensive care unit. METHODS : Retrospective cohort study, in a period of one year, at a general tertiary pediatric intensive care unit. The pediatric risk of mortality scores corresponding to the first 24 hours of hospitalization were recorded; additional data were collected to characterize the study population. RESULTS: 359 patients were included; the variables that were found to be risk factors for death were multiple organ dysfunction syndrome on admission, mechanical ventilation, use of vasoactive drugs, hospital‐acquired infection, parenteral nutrition and duration of hospitalization (p < 0,0001). Fifty‐four patients (15%) died; median pediatric risk of mortality score was significantly lower in patients who survived (p = 0,0001). The ROC curve yielded a value of 0.76 (CI 95% 0,69–0,83) and the calibration was shown to be adequate. DISCUSSION: It is imperative for pediatric intensive care units to implement strict quality controls to identify groups at risk of death and to ensure the adequacy of treatment. Although some authors have shown that the PRISM score overestimates mortality and that it is not appropriate in specific pediatric populations, in this study pediatric risk of mortality showed satisfactory discriminatory performance in differentiating between survivors and non‐survivors. CONCLUSIONS: The pediatric risk of mortality score showed adequate discriminatory capacity and thus constitutes a useful tool for the assessment of prognosis for pediatric patients admitted to a tertiary pediatric intensive care units. PMID

  8. Pediatric myositis ossificans mimicking osteosarcoma.

    PubMed

    Yamaga, Kensaku; Kobayashi, Eisuke; Kubota, Daisuke; Setsu, Nokitaka; Tanaka, Yuya; Minami, Yusuke; Tanzawa, Yoshikazu; Nakatani, Fumihiko; Kawai, Akira; Chuman, Hirokazu

    2015-10-01

    Myositis ossificans (MO) is a rare benign cause of heterotopic bone formation in soft tissue that most commonly affects young adults, typically following trauma. We report the case of an 11-year-old girl who developed MO mimicking osteosarcoma in her right shoulder. Plain radiography and computed tomography showed poorly defined flocculated densities in the soft tissue and a periosteal reaction along the proximal humerus. On magnetic resonance imaging, the mass displayed an ill-defined margin and inhomogeneous signal change. Histologically, the mass had a pseudosarcomatous appearance. Based on these findings, the patient was initially misdiagnosed with osteosarcoma at another hospital. The diagnosis was difficult because the patient was 11 years old and had no trauma history, with atypical radiographic changes and a predilection for the site of origin for osteosarcomas. We finally made the correct diagnosis of MO by carefully reviewing and reflecting on the pathological differences between stages. © 2015 Japan Pediatric Society.

  9. Pediatric Nurse Practitioner Program: Theories for Extended Pediatric Nursing Practice.

    ERIC Educational Resources Information Center

    Brady, Margaret A.

    A description is provided of "Theories for Extended Pediatric Nursing Practice," a required course for pediatric and family nurse practitioner students in a California state university program. The course description presents information on the curricular placement of the course, prerequisites, in-class time allotments, and the focus of the course…

  10. MTA applications in pediatric dentistry

    PubMed Central

    MATURO, P.; COSTACURTA, M.; BARTOLINO, M.; DOCIMO, R.

    2010-01-01

    SUMMARY The aim of this paper is to show and asses the clinical applications of the Mineral Trioxide Aggregate (MTA) in pediatric dentistry, either on primary teeth or on immature apex permanent teeth. We have described the primary tooth pulpotomy technique using MTA, that is characterized by a superior biocompatibility and a sealing ability that make it a more suitable compound compared to other materials in terms of result prediction on a long-term basis. We have also reported the direct capping technique using MTA on immature apex teeth; in these particular cases, MTA is undoubtedly preferable to conventional materials, especially in what its sealing characteristics concern. Furthermore, we have explained the apexogenesis clinical procedure, in which after a chamber pulpotomy on incomplete root development teeth, MTA is used in direct contact with the pulpar stump in order to save the root pulp vitality, allowing the apex and relative canal walls physiological maturation to take place. In case of necrotic teeth with immature apex, we describe the possibility of using MTA as an apical barrier making the apexification treatment faster and predictable, taking profit from its biocompatibility quality, its sealing ability and setting characteristic in humid environments. In all described applications, MTA has demonstrated to be a very versatile and extremely trustworthy material. Either literature and results obtained from the present experience, show how the use of MTA in Pediatric Dentistry, compared to commonly used materials, translates into pulp or periapical tissues being less swollen and, thus, guaranteeing a higher prediction of the therapeutic result on a short-term basis and on a long-term one. PMID:23285367

  11. Pediatric priority in kidney allocation: challenging its acceptability.

    PubMed

    Capitaine, Laura; Van Assche, Kristof; Pennings, Guido; Sterckx, Sigrid

    2014-06-01

    Any organ which is allocated to one individual represents a missed opportunity for someone else. Given the important repercussions which organ allocation policies inevitably have for certain people, any prioritization policy should rest on a solid argumentative basis. In this study, we analyze the widespread practice of prioritizing pediatric patients in the allocation of kidneys. While official policy documents offer no arguments in support of pediatric priority, such arguments can be found in the academic literature on pediatric renal transplantation. Our study is the first to bring together and critically analyze these. We identify five commonly cited arguments and show that none of these succeeds in justifying pediatric priority policies. We argue that the legitimacy of such policies may be further undermined by their potential adverse effects on both adults and children.

  12. Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms

    PubMed Central

    Singh, Rahul; Nguyen, Linda; Motwani, Kartik; Swatek, Michelle

    2016-01-01

    Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD. PMID:28074078

  13. Prognosis and predictors of convulsion among pediatric lupus nephritis patients.

    PubMed

    Beiraghdar, Fatemeh; Maddani, Abbas; Taheri, Saeed; Sharifi-Bonab, Mir Mohsen; Esfahani, Taher; Panahi, Yunes; Einollahi, Behzad

    2009-05-01

    In this study, we aimed to analyze features and outcome of convulsion in pediatric lupus nephritis patients. We retrospectively reviewed data of 14 Iranian children with lupus nephritis who developed seizures and compared them with a group of the same number of well matched pediatric lupus nephritis patients. Higher serum creatinine levels and higher frequencies of anemia and lymphopenia were observed in the convulsion group. Multivariable logistic regression analysis revealed that the only risk factor for development of convulsion in pediatric lupus patients with nephritis was lymphopenia. Survival analysis showed that convulsion had no impact on patient and renal function outcomes in our pediatric lupus nephritis subjects. In conclusion, we found that lymphopenia is a predictive factor for convulsion occurrence in our patients and special attention to neurological status assessment may be needed in this situation.

  14. Innovation in pediatric clinical education: application of the essential competencies.

    PubMed

    Kenyon, Lisa K; Birkmeier, Marisa; Anderson, Deborah K; Martin, Kathy

    2015-01-01

    At the Section on Pediatrics Education Summit in July 2012, consensus was achieved on 5 essential core competencies (ECCs) that represent a knowledge base essential to all graduates of professional physical therapist education programs. This article offers suggestions for how clinical instructors (CIs) might use the ECCs to identify student needs and guide student learning during a pediatric clinical education experience. Pediatric CIs potentially might choose to use the ECCs as a reference tool in clinical education to help (1) organize and develop general, clinic-specific clinical education objectives, (2) develop and plan individualized student learning experiences, (3) identify student needs, and (4) show progression of student learning from beginner to intermediate to entry level. The ECCs may offer CIs insights into the role of pediatric clinical education in professional physical therapist education.

  15. Drug repurposing in pediatrics and pediatric hematology oncology.

    PubMed

    Blatt, Julie; Corey, Seth J

    2013-01-01

    Drug 'repurposing', that is, using old drugs for new indications, has been proposed as a more efficient strategy for drug development than the current standard of beginning with novel agents. In this review, we explore the scope of drug repurposing in pediatric hematology oncology and in pediatrics in general. Drugs commonly used in children were identified using the Harriet Lane Handbook (HLH) and searched in PubMed for different uses. Additional drugs were identified by searching PubMed and Google.com for 'drug repurposing' or 'drug repositioning'. Almost 10% of drugs with primary uses in pediatrics have been repurposed in pediatric hematology oncology or pediatrics. The observant clinician, pharmacologist and translational bioinformatician, as well as structural targeting, will have a role in discovering new repurposing opportunities.

  16. Pediatric otolaryngology: The maturation of a pediatric surgical subspecialty.

    PubMed

    Cunningham, Michael J; Lin, Aaron C

    2011-01-01

    To review the historical development of pediatric otolaryngology as a surgical subspecialty and to compare and contrast this historical development with that of pediatric surgery and pediatric urology. Literature search. A sequential comparison of these three surgical subspecialties was undertaken in terms of their early origins and founding physicians, sections and societies, standardization of training and accreditation, official recognition, and certification. Supportive materials were obtained via a literature search using the PubMed database from 1950 to the present, supplemented by archived material from the libraries of the Massachusetts Eye and Ear Infirmary and the Countway Library of the Harvard Medical School. Pediatric surgery, urology, and otolaryngology have taken somewhat parallel but also disparate paths toward surgical subspecialty establishment. Pediatric otolaryngology, despite its many accomplishments, lags behind its surgical and urologic brethren from both an accreditation and certification standpoint. Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.

  17. Control of coal combustion SO{sub 2} and NO{sub x} emissions by in-boiler injection of CMA. Final project report, July 1, 1992--December 31, 1994

    SciTech Connect

    Levendis, Y.A.

    1995-04-01

    A study was conducted to determine the efficacy of carboxylic calcium and magnesium salts (e.g., calcium magnesium acetate or CMA, CaMg{sub 2}(CH{sub 2}COOH){sub 6}) for the simultaneous removal of SO{sub 2} and NO{sub x} in oxygen-lean atmospheres. Experiments were performed in a high-temperature furnace that simulated the post-flame environment of a coal-fired boiler by providing similar temperatures and partial pressures of SO{sub 2}, NO{sub x} CO{sub 2} and O{sub 2}. When injected into a hot environment, the salts calcined and formed highly porous {open_quotes}popcorn{close_quotes}-like cenospheres. Residual MgO and/or CaCO{sub 3} and CaO reacted heterogeneously with SO{sub 2} to form MgSO{sub 4} and/or CaCO{sub 4}. The organic components - which can be manufactured from wastes such as sewage sludge - gasified and reduced NO{sub x }to N{sub 2} efficiently if the atmosphere was moderately fuel-rich. Dry-injected CMA particles at a Ca/S ratio of 2, residence time of 1 second and bulk equivalence ratio of 1.3 removed over 90% of SO{sub 2} and NO{sub x} at gas temperatures {>=} 950{degrees}C. When the furnace isothermal zone was {<=} 950{degrees}C, Ca was essentially inert in the furnace quenching zone, while Mg continued to sorb SO{sub 2} as the gas temperature cooled at a rate of -130{degrees}C/sec. Hence, the removal of SO{sub 2} by CMA could continue for nearly the entire residence time of emissions in the exhaust stream of a power plant. Additional research is needed to improve the efficiency and reduce the cost of the relatively expensive carboxylic acid salts as dual SO{sub 2}-NO{sub x} reduction agents. For example, wet injection of the salts could be combined with less expensive hydrocarbons such as lignite or even polymers such as poly(ethylene) that could be extracted from the municipal waste stream.

  18. Pediatric Dental Sedation Research: Where Do We Stand Today?

    PubMed

    Mittal, N; Goyal, A; Jain, K; Gauba, K

    2015-01-01

    Despite the voluminous literature addressing the safety and efficacy of various sedative agents in the pediatric dental setting, the quality literature to form evidence based pediatric dental sedation practice is not available. Our search through PUBMED showed that during 1985-2012, a total of 184 original research papers on pediatric dental sedation were reported, and midazolam clearly dominated with 88 trials on this agent. Despite these large numbers of papers, Cochrane Review was able to pool a weak evidence in favor of midazolam. Data pooling from five heterogeneous high risk of bias trials showed that oral midazolam is associated with more cooperative behavior when compared to a placebo. Further, a very weak evidence regarding efficacy of nitrous oxide was collected from two trials, which could not be pooled. These findings draw attention to the need to address the shortcomings in the current state of pediatric dental sedation research. The present article has been focused on the current status of pediatric dental sedation research, and the limitations in the current research methodology. This paper also suggests recommendations for future research in the field of pediatric dental sedation.

  19. The team approach to pediatric asthma education.

    PubMed

    Capen, C L; Dedlow, E R; Robillard, R H; Fuller, B M; Fuller, C P

    1994-01-01

    An interdisciplinary pediatric pulmonary team of nurses, pharmacists, and social workers developed an asthma education program for presentation to children with asthma, ages 7-11, in a camp setting. Sound educational principles provide the foundation for this program, which includes a variety of teaching methods including puppet shows, games, crafts, and song. Informal evaluation methods of observation and feedback indicated that children's knowledge of asthma and asthma management increased.

  20. Group Intervention in Pediatric Rehabilitation

    ERIC Educational Resources Information Center

    LaForme Fiss, Alyssa

    2012-01-01

    Group intervention in pediatric physical and occupational therapy is an alternative to individual intervention allowing the therapist to meet the needs of multiple children at one time. Survey research indicates that approximately 40% to 60% of pediatric physical and occupational therapists use group intervention at least occasionally in practice,…

  1. Group Intervention in Pediatric Rehabilitation

    ERIC Educational Resources Information Center

    LaForme Fiss, Alyssa

    2012-01-01

    Group intervention in pediatric physical and occupational therapy is an alternative to individual intervention allowing the therapist to meet the needs of multiple children at one time. Survey research indicates that approximately 40% to 60% of pediatric physical and occupational therapists use group intervention at least occasionally in practice,…

  2. Pediatric imaging for the technologist

    SciTech Connect

    Wilmot, D.M.; Sharko, G.A.

    1987-01-01

    This manual provides an accessible store of information on pediatric imaging procedures, with clearly described techniques and instructions. The aim is to simplify the pediatric examination. Extensively illustrated, this work describes in detail correct positioning, radiation protection, and methods of immobilization. The concluding chapters clarify what is required in the final image for accurate diagnosis.

  3. Educational Preparation of Pediatric Audiologists

    ERIC Educational Resources Information Center

    Roush, Jackson

    2010-01-01

    Pediatric audiologists play a vital role in detection, diagnosis, and intervention for young children with hearing loss and their families. Preparing the next generation of pediatric audiologists necessitates a creative approach that balances the requirements of a broad curriculum with the special skills needed to serve a unique and varied…

  4. Educational Preparation of Pediatric Audiologists

    ERIC Educational Resources Information Center

    Roush, Jackson

    2010-01-01

    Pediatric audiologists play a vital role in detection, diagnosis, and intervention for young children with hearing loss and their families. Preparing the next generation of pediatric audiologists necessitates a creative approach that balances the requirements of a broad curriculum with the special skills needed to serve a unique and varied…

  5. A history of pediatric immunology.

    PubMed

    Stiehm, E Richard; Johnston, Richard B

    2005-03-01

    Immunology has played a prominent role in the history of medicine. Pediatric immunologists have focused on immune aberrations in pediatric disorders, particularly those involving host defense mechanisms. These efforts have paid rich dividends in terms of fundamental knowledge of the immune system and major therapeutic advances, including 1) i.v. immunoglobulin therapy, 2) hematopoietic stem cell transplantation, and 3) gene therapy. Pediatric immunology as an organized discipline emerged in the early 1950s, when pediatricians and their basic scientist colleagues began to focus on clinical and basic research related to immunodeficiency. Since then, key organizations and infrastructure have been developed to support this research and the clinical care of immunodeficient patients. We review here the evolution of contemporary pediatric immunology, particularly in North America, from its roots in 19th-century Europe to its current expression as one of the fundamental scientific and clinical disciplines of pediatrics.

  6. Recent developments in pediatric headache.

    PubMed

    Hershey, Andrew D

    2010-06-01

    This review will focus on some of the recent findings in pediatric headache including headache characteristics, epidemiology, comorbid associations and treatment updates. Pediatric headache remains a frequent health problem for children and their families, yet there remain many gaps in our knowledge. This review will broadly address some of the recent findings and highlight the gaps in our understanding and treatment of pediatric headache. There will be a focus on pediatric migraine as this has been the best characterized and studied. Our understanding of pediatric headache is improving with increased recognition of the characteristics and associated symptomology. This should further guide the individualized treatment approaches for improved outcome and reduction of progression into adulthood.

  7. Pediatric brain tumor cell lines.

    PubMed

    Xu, Jingying; Margol, Ashley; Asgharzadeh, Shahab; Erdreich-Epstein, Anat

    2015-02-01

    Pediatric brain tumors as a group, including medulloblastomas, gliomas, and atypical teratoid rhabdoid tumors (ATRT) are the most common solid tumors in children and the leading cause of death from childhood cancer. Brain tumor-derived cell lines are critical for studying the biology of pediatric brain tumors and can be useful for initial screening of new therapies. Use of appropriate brain tumor cell lines for experiments is important, as results may differ depending on tumor properties, and can thus affect the conclusions and applicability of the model. Despite reports in the literature of over 60 pediatric brain tumor cell lines, the majority of published papers utilize only a small number of these cell lines. Here we list the approximately 60 currently-published pediatric brain tumor cell lines and summarize some of their central features as a resource for scientists seeking pediatric brain tumor cell lines for their research.

  8. Where We Stand—CMA Position Papers: • Abortion • Acupuncture • Chiropractic • Confidentiality • Cost of Care • Drug Abuse • Environmental Health • Health Education for the Public • Health in the United States • Health Quackery • Health Maintenance Organizations and Prepaid Health Plans • Health Manpower • National Health Insurance • Physician's Assistants • Physician Unions • Professional Standards Review Organizations • Quality Medical Care

    PubMed Central

    1973-01-01

    To serve the interests of members and to function in the public interest, the California Medical Association must set policies and take positions on current issues affecting the health care of Californians. These policies then guide the activities of the Association in fulfilling its leadership role and its responsibility to the public. Delegates, elected by the membership of CMA's component medical societies, meet annually to deliberate and determine the policies and courses of action for the Association. Between meetings of these Delegates, the CMA Councilors, elected by their district membership, implement the directives of the Delegates and set interim policies. By this democratic process, the membership governs the CMA. Association members must be informed if they are to participate effectively in the affairs of their medical organizations. To disseminate better understanding of CMA's activities, position papers on current issues have been developed. They are based on House of Delegates resolutions and Council actions. Entitled “Where We Stand on Medical and Health Issues,” these papers represent the current policy positions of CMA. Each paper is annotated to give the reference source of the policy actions. As with any organization, CMA policies are subject to timely revision. When policies are amended or new policies are adopted, new papers will be developed. PMID:4148533

  9. Pediatric cardiac emergencies.

    PubMed

    Lee, C; Mason, L J

    2001-06-01

    Successful management of pediatric cardiac emergencies requires an accurate diagnosis to institute an appropriate plan of therapy. The diagnosis, however, is not always straightforward, as evidenced by the nonspecific clinical picture that can be presented by congenital heart defects. Entertaining the possibility of a cardiac problem in neonates with pulmonary symptoms unresponsive to standard therapies is crucial for successful management of patients with congenital heart disease. In addition to ventilatory support, prostaglandin E1 infusions or emergency interventional cardiac catheterization is often a life-saving initial measure in patients with acutely decompensated congenital cardiac lesions that require a patent ductus arteriosus for survival. Pericardial tamponade is associated with various acquired and iatrogenic causes. Emergent pericardiocentesis is mandatory when cardiovascular compromise occurs. The goal of anesthetic management is to maintain cardiac output. With the increasing use of central venous catheters in neonatal ICUs and the high mortality rate for central venous catheter-related cardiac tamponade, the diagnosis must be considered in any patient with a central venous catheter in situ who acutely develops unexplained hypotension, bradycardia, and diminished pulses. Arrhythmias also can cause hemodynamic instability in infants and children. Supraventricular tachycardia is by far the most common emergently presenting arrhythmia in the pediatric population. Unstable patients require immediate intravenous adenosine or synchronized cardioversion. Complete heart block is rare, but it can lead to congestive heart failure and occasionally to cardiovascular collapse and sudden death. Emergency treatment of complete heart block includes pharmacologic support and temporary or permanent pacemaker placement as indicated. In infants, congestive heart failure usually is related to congenital heart disease, whereas in older children, it tends to be secondary

  10. Urinary biomarkers in pediatric appendicitis.

    PubMed

    Salö, Martin; Roth, Bodil; Stenström, Pernilla; Arnbjörnsson, Einar; Ohlsson, Bodil

    2016-08-01

    The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score (PAS), to see whether this could improve the accuracy of diagnosing appendicitis. A prospective study of children with suspected appendicitis was conducted with assessment of PAS, routine blood tests, and measurements of four novel urinary biomarkers: leucine-rich α-2-glycoprotein (LRG), calprotectin, interleukin 6 (IL-6), and substance P. The biomarkers were blindly determined with commercial ELISAs. Urine creatinine was used to adjust for dehydration. The diagnosis of appendicitis was based on histopathological analysis. Forty-four children with suspected appendicitis were included, of which twenty-two (50 %) had confirmed appendicitis. LRG in urine was elevated in children with appendicitis compared to children without (p < 0.001), and was higher in children with gangrenous and perforated appendicitis compared to those with phlegmonous appendicitis (p = 0.003). No statistical significances between groups were found for calprotectin, IL-6 or substance P. LRG had a receiver operating characteristic area under the curve of 0.86 (95 % CI 0.79-0.99), and a better diagnostic performance than all routine blood tests. LRG in conjunction with PAS showed 95 % sensitivity, 90 % specificity, 91 % positive predictive value, and 95 % negative predictive value. LRG, adjusted for dehydration, is a promising novel urinary biomarker for appendicitis in children. LRG in combination with PAS has a high diagnostic performance.

  11. Cervical spine injuries in pediatric patients.

    PubMed

    Platzer, Patrick; Jaindl, Manuela; Thalhammer, Gerhild; Dittrich, Stefan; Kutscha-Lissberg, Florian; Vecsei, Vilmos; Gaebler, Christian

    2007-02-01

    Cervical spine injuries are uncommon in pediatric trauma patients. Previous studies were often limited by the small numbers of patients available for evaluation. The aim of this study was to determine the incidence and characteristics of pediatric cervical spine injuries at this Level 1 trauma center and to review the authors' experiences with documented cases. This study retrospectively analyzed the clinical records of all pediatric trauma patients with skeletal and/or nonskeletal injuries of the spine that were admitted to this Level 1 trauma center between 1980 and 2004. Those with significant injuries of the cervical spine were identified and included in this study. Pediatric patients were defined as patients younger than the age of 17 years. In addition, they were stratified by age into two study groups: group A included patients aged 8 years or fewer and group B contained patients from the ages of 9 to 16 years. We found 56 pediatric patients with injuries of the cervical spine that met criteria for inclusion. Thirty-one female and 25 male patients with an average age of 8.9 years (range, 1-16 years) sustained significant skeletal and/or nonskeletal injuries of the cervical spine and were entered in this study. Thirty patients (54%) were aged 8 years or fewer and entered into study group A, whereas 26 patients (46%) from the ages of 9 to 16 met criteria for inclusion in study group B. An analysis of data revealed that younger patients (group A) showed significantly more injuries of the upper cervical spine, whereas older children (group B) sustained significantly more injuries of the lower level. Spinal cord injuries without radiographic findings were only found in study group A. In addition, younger children were more likely injured by motor vehicle crashes, whereas older children more commonly sustained C-spine injuries during sports activities. Two-thirds of our patients showed neurologic deficits, and the overall mortality was 28%. The results of our

  12. [Ultrasound in pediatric dermatology].

    PubMed

    García-Martínez, F J; Muñoz-Garza, F Z; Hernández-Martín, A

    2015-11-01

    Cutaneous ultrasound is particularly useful in pediatric dermatology to diagnose numerous diseases without the need to use invasive tests. The present articles reviews some frequent dermatological entities in children whose study can be simplified through cutaneous ultrasound. This article also provides practical recommendations reported in the literature that may facilitate ultrasound examination, with special mention of benign tumoural disease, both congenital and acquired, and vascular anomalies. Copyright © 2015 Academia Española de Dermatología y Venereología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Pediatric Genitourinary Oncology

    PubMed Central

    Dénes, Francisco Tibor; Duarte, Ricardo Jordão; Cristófani, Lílian Maria; Lopes, Roberto Iglesias

    2013-01-01

    Tumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management. PMID:24400293

  14. Pediatric Testicular Torsion.

    PubMed

    Bowlin, Paul R; Gatti, John M; Murphy, J Patrick

    2017-02-01

    The pediatric patient presenting with acute scrotal pain requires prompt evaluation and management given the likelihood of testicular torsion as the underlying cause. Although other diagnoses can present with acute testicular pain, it is important to recognize the possibility of testicular torsion because the best chance of testicular preservation occurs with expeditious management. When testicular torsion is suspected, prompt surgical exploration is warranted. A delay in surgical management should not occur in an effort to obtain confirmatory imaging. When torsion is discovered, the contralateral testicle should undergo fixation to reduce the risk of asynchronous torsion.

  15. Pediatric hereditary angioedema

    PubMed Central

    MacGinnitie, Andrew J

    2014-01-01

    Hereditary angioedema (HAE) is a lifelong illness characterized by recurrent swelling of the skin, intestinal tract, and, ominously, the upper airway. It is caused by inadequate activity of the protein C1-inhibitor, with dysfunction in the kallikrein/bradykinin pathway underlying the clinical symptoms. In addition to the physical symptoms, patients experience significant decrements in vocational and school achievement as well as in overall quality of life. Symptoms often begin in childhood and occur by age 20 in most patients, but life-threatening attacks are uncommon in the pediatric population. The availability of new therapies has transformed the management of HAE. PMID:24313851

  16. Pediatric Liver Transplantation.

    PubMed

    Rawal, Nidhi; Yazigi, Nada

    2017-06-01

    Excellent outcomes over the last 3 decades have made liver transplantation the treatment of choice for many advanced liver disorders. This success also opened liver transplantation to new indications such as liver tumors and metabolic disorders. The emergence of such new indications for liver transplantation is bringing a new stream of patients along with disease-specific challenges. The cumulative number of liver transplant recipients is peaking, requiring novel systems of health care delivery that meet the needs of this special patient population. This article reviews updates and new development in pediatric liver transplantation. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Pediatric Renal Neoplasms.

    PubMed

    Ranganathan, Sarangarajan

    2009-03-01

    Renal tumors in childhood consist of a diverse group of tumors ranging from the most common Wilms' tumor, to the uncommon and often fatal rhabdoid tumor. Diagnosis is based on morphologic features and aided by ancillary techniques such as immunohistochemistry and cytogenetics. Molecular techniques have helped identify a group of pediatric renal cell carcinomas that have specific translocations, called translocation-associated carcinomas. Differential diagnosis of the various tumors is discussed. Pathogenesis and nephroblastomatosis, the precursor lesions of Wilms tumor, also are discussed briefly, as are the handling of these tumor specimens and prognostic factors. Copyright © 2009 Elsevier Inc. All rights reserved.

  18. Procedural pediatric dermatology.

    PubMed

    Metz, Brandie J

    2013-04-01

    Due to many factors, including parental anxiety, a child's inability to understand the necessity of a procedure and a child's unwillingness to cooperate, it can be much more challenging to perform dermatologic procedures in children. This article reviews pre-procedural preparation of patients and parents, techniques for minimizing injection-related pain and optimal timing of surgical intervention. The risks and benefits of general anesthesia in the setting of pediatric dermatologic procedures are discussed. Additionally, the surgical approach to a few specific types of birthmarks is addressed.

  19. ADVANCES IN PEDIATRIC SURGERY

    PubMed Central

    Richards, Victor

    1952-01-01

    Recent advances in pediatric surgery have been made in several fields. Hydrocephalus is again being treated by draining the cerebrospinal fluid into either the ureter, the mastoid antrum or the peritoneal cavity. Funnel chest should be corrected surgically. Congenital atresia of the esophagus is best treated by a one-stage operative repair. Patent ductus should be closed. Operations are available for cyanotic children. Intussusception is again being treated by barium enema in selected cases. Megacolon can be benefited by surgical procedures, which now are directed at the distal spastic segment rather than the proximal dilated segment. PMID:13009476

  20. Incarcerated Pediatric Hernias.

    PubMed

    Abdulhai, Sophia A; Glenn, Ian C; Ponsky, Todd A

    2017-02-01

    Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Pediatric environmental health.

    PubMed Central

    Walker, Bailus

    2005-01-01

    The links between environmental agents, environmental conditions, and disease and disability among children are receiving increasing attention. Evidence abounds that children are more susceptible than adults to the damaging effects of environmental agents and conditions. This evidence is illuminated by the much-publicized and expanding research agenda on the prevention, recognition, diagnosis and treatment of environmentally related disease in the pediatric population. Encouragingly, advances in molecular biology and other sciences are providing important tools to aid pediatricians and other healthcare professionals in meeting the environmental health needs of children. PMID:15712790

  2. Cushing syndrome in pediatrics.

    PubMed

    Stratakis, Constantine A

    2012-12-01

    Cushing syndrome is characterized by truncal obesity, growth deceleration, skin changes, muscle weakness, and hypertension. Cushing syndrome in childhood usually results from the exogenous administration of glucocorticoids. This article presents the causes and discusses the treatment of endogenous Cushing syndrome. It also discusses the clinical and molecular genetics of inherited forms of this syndrome. Cushing syndrome needs to be diagnosed and treated properly when first recognized; improper treatment can turn this otherwise completely curable disorder into a chronic ailment. Barriers to optimal care of a pediatric patient with Cushing syndrome are discussed. Published by Elsevier Inc.

  3. Pediatric asthma controller therapy.

    PubMed

    Anselmo, Mark

    2011-02-01

    The treatment of children with asthma has historically relied upon expert opinion using data extrapolated from adult studies. Over the past few years, landmark studies have been completed providing healthcare professionals with evidence on which a reasonable approach can be made for children suffering from this common and serious disease. Asthmatic phenotype in children, unlike adults, tends to differ according to age, which must be taken into account as well as triggers, severity, and level of control. The care of the child with asthma is complex, but accumulating data have demonstrated that we are on the right path for optimizing control while reducing the burden of side effects. The newest Global Initiative for Asthma (GINA) guidelines, as well as recent updates from the landmark CAMP (Childhood Asthma Management Program) study and information from the PACT (Pediatric Asthma Control Trial) and budesonide/formoterol controller and reliever studies, along with recent comparisons of higher dose inhaled corticosteroids (ICS), and ICS/long-acting β(2)-adrenoceptor agonist (LABA) combination and leukotriene receptor antagonist (LTRA) therapies in children have clarified a few of the big questions in pediatric asthma. For children with asthma aged 5 years and older, the CAMP trial demonstrated that regular use of ICS reduces the frequency of symptoms; however, height was adversely affected and there is no evidence for altering the natural history of asthma. In patients aged 6 years and over whose asthma is uncontrolled on ICS alone, combination therapy with ICS and a LABA has been recently compared with the use of higher dose ICS and the addition of an LTRA in pediatric patients. The addition of a LABA statistically will be of most benefit; however, some children will have optimal control with doubling the baseline dose of ICS or addition of an LTRA. Use of budesonide/formoterol as a controller and reliever therapy extends the time to first exacerbation versus

  4. Issues in pediatric immunization.

    PubMed

    Sharts-Hopko, Nancy C

    2009-01-01

    Revisions to the Centers for Disease Control and Prevention's pediatric immunization guidelines have generated a renewed focus on controversies associated with the nation's childhood vaccination program. Among these issues are adherence with and access to required vaccinations, concerns about individuals' rights in relation to government-mandated vaccinations, ongoing worry about adverse effects associated with immunizations, and questions about how best to protect immunocompromised and ill children. This article addresses these questions and presents strategies that can be used by clinicians to improve adherence with vaccination guidelines.

  5. Pediatric ambulatory anesthesia.

    PubMed

    August, David A; Everett, Lucinda L

    2014-06-01

    Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Pediatric cerebral aneurysms.

    PubMed

    Gemmete, Joseph J; Toma, Ahmed K; Davagnanam, Indran; Robertson, Fergus; Brew, Stefan

    2013-11-01

    Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Pediatric Hodgkin Lymphoma

    PubMed Central

    Ferrari, Cristina; Niccoli Asabella, Artor; Merenda, Nunzio; Altini, Corinna; Fanelli, Margherita; Muggeo, Paola; De Leonardis, Francesco; Perillo, Teresa; Santoro, Nicola; Rubini, Giuseppe

    2017-01-01

    Abstract We investigated the prognostic value of interim 18F-FDG PET/CT (PET-2) in pediatric Hodgkin lymphoma (pHL), evaluating both visual and semiquantitative analysis. Thirty pHL patients (age ≤16) underwent serial 18F-FDG PET/CT: at baseline (PET-0), after 2 cycles of chemotherapy (PET-2) and at the end of first-line chemotherapy (PET-T). PET response assessment was carried out visually according to the Deauville Score (DS), as well as semiquantitatively by using the semiquantitative parameters reduction from PET-0 to PET-2 (ΔΣSUVmax0–2, ΔΣSUVmean0–2). Final clinical response assessment (outcome) at the end of first-line chemotherapy was the criterion standard, considering patients as responders (R) or nonresponders (NR). Disease status was followed identifying patients with absence or relapsed/progression disease (mean follow-up: 24 months, range 3–78). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual and semiquantitative assessment were calculated; furthermore, Fisher exact test was performed to evaluate the association between both visual and semiquantitative assessment and outcome at the end of the first-line chemotherapy. The prognostic capability of PET-2 semiquantitative parameters was calculated by ROC analysis and expressed as area under curve (AUC). Finally, progression-free survival (PFS) was analyzed according to PET-2 results based on the 5-point scale and semiquantitative criteria, using the Kaplan–Meier method. Based on the outcome at the end of first-line chemotherapy, 5 of 30 patients were NR, the remnant 25 of 30 were R. Sensitivity, specificity, PPV, NPV, and accuracy of visual analysis were 60%,72%,30%,90%,70%; conversely, sensitivity, specificity, PPV, NPV, and accuracy of semiquantitative assessment were 80%, 92%, 66.7%, 95.8%, 90%. The highest AUC resulted for ΔΣSUVmax0–2 (0.836; cut-off <12.5; sensitivity 80%; specificity 91%). The association between

  8. Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients.

    PubMed

    El-Gamasy, Mohamed Abd El-Aziz; Elezz, Ahmed Abd El Basset Abo; Basuni, Ahmed Sobhy Mohamed; Elrazek, Mohamed El Sayed Ali Abd

    2016-11-01

    Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS) in Tanta University Emergency Hospital. The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR), Base Excess (BE), and Glasgow Coma Scale (GCS) values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS.

  9. Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients

    PubMed Central

    El-Gamasy, Mohamed Abd El-Aziz; Elezz, Ahmed Abd El Basset Abo; Basuni, Ahmed Sobhy Mohamed; Elrazek, Mohamed El Sayed Ali Abd

    2016-01-01

    Background: Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. Aim of the Work: This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS) in Tanta University Emergency Hospital. Materials and Methods: The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. Results: BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. Conclusion: The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR), Base Excess (BE), and Glasgow Coma Scale (GCS) values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS. PMID:27994378

  10. The Pediatric Urinary Tract and Medical Imaging.

    PubMed

    Penny, Steven M

    2016-01-01

    The pediatric urinary tract often is assessed with medical imaging. Consequently, it is essential for medical imaging professionals to have a fundamental understanding of pediatric anatomy, physiology, and common pathology of the urinary tract to provide optimal patient care. This article provides an overview of fetal development, pediatric urinary anatomy and physiology, and common diseases and conditions of the pediatric urinary tract.

  11. Pediatric spinal clear cell meningioma. Case report.

    PubMed

    Colen, Chaim B; Rayes, Mahmoud; McClendon, Jamal; Rabah, Raja; Ham, Steven D

    2009-01-01

    In this report the authors describe a unique case of spinal clear cell meningioma in a 13-year-old girl. Clear cell meningiomas (CCMs) are not uncommon. To the authors' knowledge, 14 cases of pediatric CCM occurring in the spinal canal have been reported. Factors lending resistance to meningioma initiation and invasion are analyzed. This 13-year-old girl presented with pain radiating down her left leg. Admission MR imaging showed an inhomogeneous enhancing intradural-extramedullary mass at the L4-5 level. Resection revealed a CCM, and radiotherapy was subsequently administered. Postoperatively there has been no recurrence in > 2 years. In this paper the authors report a case of CCM and provide a comprehensive literature review on this disease. Current recommendations for its management are still debatable, especially in the pediatric population, and the authors propose an algorithm for its treatment and surveillance.

  12. Pediatric-onset extracephalic stabbing pain.

    PubMed

    Kakisaka, Yosuke; Kano, Shinsuke; Hino-Fukuyo, Naomi; Uematsu, Mitsugu; Kure, Shigeo

    2014-08-01

    Idiopathic stabbing headache is a primary headache defined as "transient stabs of pain in the head that occur spontaneously in the absence of underlying organic disease." Although its variant form, stabbing pain with extracephalic distribution, has been reported in rare adult cases, pediatric presentation is extremely rare. We report an 8-year-old boy suffering from severe stabbing pain in the left side of the chest, right side of the abdomen, and right knee lasting 2 to 3 minutes with increasing frequency. He was completely normal between attacks. The attack was not accompanied with headache initially. Investigation showed no abnormality. A diagnosis of extracephalic stabbing pain was made. The patient's symptoms were ameliorated by administration of valproic acid. This report illustrates that extracephalic stabbing pain can occur in pediatric patients. It is important to be aware of this peculiar condition because the pain is so severe, and it can be treatable with medication. © The Author(s) 2013.

  13. Pediatric allergy and immunology in Brazil.

    PubMed

    Rosario-Filho, Nelson A; Jacob, Cristina M; Sole, Dirceu; Condino-Neto, Antonio; Arruda, Luisa K; Costa-Carvalho, Beatriz; Cocco, Renata R; Camelo-Nunes, Inês; Chong-Neto, Herberto J; Wandalsen, Gustavo F; Castro, Ana P M; Yang, Ariana C; Pastorino, Antonio C; Sarinho, Emanuel S

    2013-06-01

    The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X-linked hyper-IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil.

  14. [New horizons in pediatrics].

    PubMed

    Grossman, Zachi

    2012-06-01

    The profession of pediatrics is constantLy changing. New morbidities are replacing old ones, as a reflection of the changes in society. Even today, old and rare morbidities, like scurvy or acute urinary retention, can be encountered in special settings and populations such as handicapped and developmentally delayed children. The availability of ever newer genetic tests highlights the duty of pediatricians to constantly update families for carrier detection, but also raises questions on the cLinical significance of asymptomatic mutations. Vaccination is one of the most effective pubLic health measures, but failure of medical staff to follow self vaccination recommendations might jeopardize protecting the children. Anti vaccination movement is rapidly growing due to the Internet. However, we must acknowledge the benefits inherent in Internet forums, for example, adolescents consulting anonymously regarding pubertal issues. A new and most needed aspect of care is treatment of pain in children. Increased staff awareness concerning anaLgesia is needed as well as promoting the use of medical clowns for anxiety and pain provoking procedures. Delivering appropriate healthcare to different societal demographic sectors is a challenge for pediatricians. The approach to fever phobia among ultra orthodox parents and advocacy for safety recommendations in the Arab population are two such exampLes. Finally, we shouLd always strive for innovative approaches in pediatric diseases affecting quality of life, and celiac disease is certainly promising in this direction.

  15. Abdominal emergencies in pediatrics.

    PubMed

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  16. Pediatric Hand Fractures

    PubMed Central

    Nellans, Kate W.; Chung, Kevin C.

    2014-01-01

    Summary Pediatric hand fractures are common childhood injuries. Identification of the fractures in the emergency room setting can be challenging owing to the physes and incomplete ossification of the carpus that are not revealed in the xrays. Most simple fractures can be treated with appropriate immobilization through buddy taping, finger splints, or casting. If correctly diagnosed, reduced and immobilized, these fractures usually result in excellent clinical outcomes. However, fractures may require operative stabilization if they have substantial angulation or rotation, extend into the joint, or cannot be held in a reduced position with splinting alone. Most fractures can be treated operatively with closed reduction and percutaneous pinning if addressed within the first week following the injury. In children, the thick, vascular-rich periosteum and bony remodeling potential make anatomic reductions and internal fixation rarely necessary. Most fractures complete bony healing in 3-4 weeks, with the scaphoid being a notable exception. Following immobilization, children rarely develop hand stiffness and formal occupational therapy is usually not necessary. Despite the high potential for excellent outcomes in pediatric hand fractures, some fractures remain difficult to diagnose and treat. PMID:24209954

  17. Pediatric Intracranial Hypertension.

    PubMed

    Aylward, Shawn C; Reem, Rachel E

    2017-01-01

    Primary (idiopathic) intracranial hypertension has been considered to be a rare entity, but with no precise estimates of the pediatric incidence in the United States. There have been attempts to revise the criteria over the years and adapt the adult criteria for use in pediatrics. The clinical presentation varies with age, and symptoms tending to be less obvious in younger individuals. In the prepubertal population, incidentally discovered optic disc edema is relatively common. By far the most consistent symptom is headache; other symptoms include nausea, vomiting tinnitus, and diplopia. Treatment mainstays include weight loss when appropriate and acetazolamide. Furosemide may exhibit a synergistic benefit when used in conjunction with acetazolamide. Surgical interventions are required relatively infrequently, but include optic nerve sheath fenestration and cerebrospinal fluid shunting. Pain and permanent vision loss are the two major complications of this disorder and these manifestations justify aggressive treatment. Once intracranial hypertension has resolved, up to two thirds of patients develop a new or chronic headache type that is different from their initial presenting headache.

  18. Pediatric Hypovitaminosis D

    PubMed Central

    Ariganjoye, Rafiu

    2017-01-01

    Vitamin D, a secosteroid, is essential for the development and maintenance of healthy bone in both the adult and pediatric populations. Low level of 25-hydroxy vitamin D (25-(OH)-D) is highly prevalent in children worldwide and has been linked to various adverse health outcomes including rickets, osteomalacia, osteomalacic myopathy, sarcopenia, and weakness, growth retardation, hypocalcemia, seizure and tetany, autism, cardiovascular diseases, diabetes mellitus, cancers (prostate, colon, breast), infectious diseases (viral, tuberculosis), and autoimmune diseases, such as multiple sclerosis and Hashimoto’s thyroiditis. Risk factors for hypovitaminosis D are people with darker skin pigmentation, use of sunscreen, insufficient ultraviolet B exposure, prematurity, living in northern latitudes, malnutrition, obesity, exclusive breastfeeding, low maternal vitamin D level, certain medications, drinking unfortified cow’s milk, liver failure, chronic renal insufficiency, cystic fibrosis, asthma, and sickle cell hemoglobinopathy. This review highlights and summarizes the molecular perspectives of vitamin D deficiency and its potential adverse health outcomes in pediatric age groups. The recommended treatment regimen is beyond the scope of this review. PMID:28229097

  19. Pediatric Lung Transplantation.

    PubMed

    Sweet, Stuart C

    2017-06-01

    Pediatric lung transplant is a viable option for treatment of end-stage lung disease in children, with > 100 pediatric lung transplants reported to the Registry of the International Society of Heart and Lung Transplantation each year. Long-term success is limited by availability of donor organs, debilitation as a result of chronic disease, impaired mucus clearance resulting from both surgical and pharmacologic interventions, increased risk for infection resulting from immunosuppression, and most importantly late complications, such as chronic lung allograft dysfunction. Opportunities for investigation and innovation remain in all of these domains: (1) Ex vivo lung perfusion is a promising technology with the potential for increasing the lung donor pool, (2) evolving extracorporeal support strategies coupled with effective rehabilitation will effectively bridge critically ill patients to transplant, and most importantly, (3) research efforts intended to increase our understanding of the underlying mechanisms of chronic lung allograft dysfunction will ultimately lead to the development of effective therapies to prevent or treat the variety of chronic lung allograft dysfunction presentations. Copyright © 2017 by Daedalus Enterprises.

  20. Pediatric office emergencies.

    PubMed

    Klig, Jean E; O'Malley, Patricia J

    2007-10-01

    An emergency in the office setting can be problematic without adequate staff, support, tools, and protocols. Though many emergencies are not immediately life-threatening, one risks the 'worst case scenario' occurring if not adequately prepared. Pediatric patients are prone to respiratory distress and compromise in many emergencies, and can rapidly decompensate without adequate support. A review of the history of emergency medical services for children and the framework for office emergency preparedness offers insight into current challenges for primary care providers. Research has demonstrated that many primary care offices and clinics are ill prepared to handle common pediatric emergencies. Reliance on the Emergency Medical Services system is insufficient to assure optimal outcomes, especially given variations in the equipment, training, and experience of Emergency Medical Services providers in the care of children, and in remote areas where access may be delayed. Preparation and practice for office emergencies through 'mock code' exercises can increase practitioner confidence and reduce anxiety to perform life-saving care. Better outcomes for office emergencies can result from staff training, availability of appropriate equipment and medications, maintenance of skills via formal and informal practice, and pathways for expeditious transfer to a definitive care facility.

  1. Imaging in pediatric liver transplantation.

    PubMed

    Monti, L; Soglia, G; Tomà, P

    2016-05-01

    Liver transplantation has become an established curative treatment in adult patients with acute or chronic end-stage liver diseases. In pediatric cases the number of cadaveric donor livers is not sufficient and to overcome the shortage of appropriate-sized whole liver grafts, technical variants of liver transplantation have been practiced. Reduced-size cadaveric and split cadaveric allografts have become an important therapeutic option, expanding the availability of size-appropriate organs for pediatric recipients with terminal liver disease. The number of pediatric deaths awaiting liver transplantation has been reduced by the introduction of living-related liver transplantation, developed to overcome the shortage of suitable grafts for children. It is important for radiologists to know that children have distinct imaging of liver transplantation that distinguish them from adults. A multidisciplinary pediatric liver transplantation team should be skilled in pediatric conditions and in associated processes, risks and complications. Radiologists should know the common pediatric liver diseases that lead to liver transplantation, the anastomotic techniques and the expected postoperative imaging findings. The aim of this study is to illustrate the role of non-invasive imaging such us ultrasonography, color Doppler ultrasonography, multidetector computed tomography and magnetic resonance imaging in the evaluation of pediatric liver transplantation and in potential liver donors.

  2. Pediatric drug development: formulation considerations.

    PubMed

    Ali, Areeg Anwer; Charoo, Naseem Ahmad; Abdallah, Daud Baraka

    2014-10-01

    Absence of safe, effective and appropriate treatment is one of the main causes of high mortality and morbidity rates among the pediatric group. This review provides an overview of pharmacokinetic differences between pediatric and adult population and their implications in pharmaceutical development. Different pediatric dosage forms, their merits and demerits are discussed. Food and Drug Administration Act of 1997 and the Best Pharmaceuticals for Children Act 2002 added 6 months patent extension and exclusivity incentives to pharmaceutical companies for evaluation of medicinal products in children. Prescription Drug User Fee Act and Food and Drug Administration Amendments Act of 2007 made it mandatory for pharmaceutical companies to perform pediatric clinical studies on new drug products. Drug development program should include additional clinical bridge studies to evaluate differences in pharmacokinetics and pharmacodynamics of drugs in adult and child populations. Additionally, pharmaceutical development should consider ease of administration, palatability, appropriate excipients, stability and therapeutic equivalency of pediatric dosage forms. Pediatric population is diverse with individual preferences and demand for custom made dosage formulations. Practically it is not feasible to have different pharmaceutical dosage forms for each group. Hence, an appropriate dosage form that can be administered across pediatric population is warranted.

  3. PROMIS® Pediatric Self Report Scales Distinguish Subgroups of Children Within and Across Six Common Pediatric Chronic Health Conditions

    PubMed Central

    DeWalt, Darren A.; Gross, Heather E.; Gipson, Debbie S.; Selewski, David T.; DeWitt, Esi Morgan; Dampier, Carlton D.; Hinds, Pamela S.; Huang, I-Chan; Thissen, David; Varni, James W.

    2015-01-01

    Purpose To conduct a comparative analysis of eight pediatric self-report scales for ages 8-17 years from the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS®) in six pediatric chronic health conditions, using indicators of disease severity. Methods Pediatric patients (N = 1,454) with asthma, cancer, chronic kidney disease, obesity, rheumatic disease, and sickle cell disease completed items from the PROMIS pediatric mobility, upper extremity functioning, depressive symptoms, anxiety, anger, peer relationships, pain interference, and fatigue self-report scales. Comparisons within the six pediatric chronic health conditions were conducted by examining differences in groups based on disease severity using markers of severity that were specific to characteristics of each disease. A comparison was also made across diseases between children who had been recently hospitalized and those who had not. Results In general, there were differences in self-reported health outcomes within each chronic health condition, with patients who had higher disease severity showing worse outcomes. Across health conditions, when children with recent hospitalizations were compared with those who had not been hospitalized in the past six months, we found significant differences in the expected directions for all PROMIS domains, except anger. Conclusions PROMIS measures discriminate between different clinically meaningful subgroups within several chronic illnesses. Further research is needed to determine the responsiveness of the PROMIS pediatric scales to change over time. PMID:25715946

  4. History of academic general and ambulatory pediatrics.

    PubMed

    Haggerty, Robert J; Green, Morris

    2003-01-01

    Academic general pediatrics and ambulatory care are closely linked to the development of the Ambulatory Pediatric Association, an organization with nearly 2000 members active in teaching, patient care, and research. Primary care, behavioral-developmental pediatrics, prevention, health promotion, community pediatrics, socioeconomic issues, cultural and ethnic diversity, advocacy, research in education, social issues, and environmental health lie within the purview of general pediatrics. In part, because of their teaching and patient care obligations, but also due to a lack of fellowship research training, many general pediatrics faculty have had difficulty in accomplishing significant research. By supporting fellowship training in general pediatrics, The Robert Wood Johnson Foundation General Pediatrics Academic Development Program and the current fellowship program supported by the Bureau of Health Manpower are important efforts to remedy this deficiency. The sciences basic to general pediatrics research include epidemiology, biostatistics, and the behavioral sciences. In addition, general pediatrics research often borrows from other sciences and collaborates with investigators in other disciplines. Partnerships between general pediatrics divisions and practicing pediatricians for teaching and research, e.g. the Community Education in Community Settings program, provides a realistic educational program for future pediatricians. The Pediatric Research in Office Setting network is another important vehicle for translation of research into the practice of general pediatrics. The steady growth of the Ambulatory Pediatric Association over the past four decades is testimony to the creativity, adaptability, and verve that has characterized the discipline of general pediatrics.

  5. Pediatric neuropsychology: toward subspecialty designation.

    PubMed

    Baron, Ida Sue; Wills, Karen; Rey-Casserly, Celiane; Armstrong, Kira; Westerveld, Michael

    2011-08-01

    Clinical neuropsychology is a rapidly expanding field of study in the psychological sciences whose practitioners are expert in the assessment, treatment, and research of individuals with known or suspected central nervous system disease or disorder. Pediatric neuropsychology has emerged as a distinct subspecialty area with related education, training, and clinical expertise for a growing number of neuropsychologists. This paper details the numerous steps taken by two affiliated organizations, the American Board of Clinical Neuropsychology and its membership organization, the American Academy of Clinical Neuropsychology, in the interest of the larger pediatric neuropsychology community and in pediatric neuropsychology subspecialty development.

  6. Adalimumab in pediatric Crohn's disease.

    PubMed

    Patel, Ashish S; Suarez, Lisbet D; Rosh, Joel R

    2016-02-01

    Adalimumab, a human monoclonal antibody to tumor necrosis factor alpha (TNF-α), was initially approved for the treatment of moderate to severe rheumatoid arthritis in 2002. In the subsequent years, its anti-inflammatory properties were applied to the treatment of psoriatic arthritis, ankylosing spondylitis, adult Crohn's disease (CD), plaque psoriasis, polyarticular juvenile idiopathic arthritis, adult ulcerative colitis and most recently in 2014, pediatric CD. The biologic era in pediatric CD has changed and redefined the therapeutic approach to this challenging lifelong disease. This article summarizes the clinical legacy of adalimumab with a focus on its most recent expanded indication, pediatric CD.

  7. Medical Comorbidities in Pediatric Headache.

    PubMed

    Jacobs, Howard; Singhi, Samata; Gladstein, Jack

    2016-02-01

    Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Pediatric facial transplantation: Ethical considerations

    PubMed Central

    Flynn, Jennifer; Shaul, Randi Zlotnik; Hanson, Mark D; Borschel, Gregory H; Zuker, Ronald

    2014-01-01

    Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement. PMID:25114614

  9. Pharmacologic Therapies for Pediatric Concussions

    PubMed Central

    Halstead, Mark E.

    2016-01-01

    Context: Pediatric concussions are common, and emphasis on correct diagnosis and management is stressed in consensus guidelines. Medications may have a role in management of concussion, but no consensus exists regarding appropriate pharmacologic therapy. Evidence Acquisition: Nonsystematic review. Study Design: Clinical review. Level of Evidence: Level 4. Results: There is limited evidence for hypertonic saline to improve posttraumatic headache in the emergency department setting. There is essentially no evidence for the use of any other medication in management of pediatric sport-related concussion. Conclusion: Further research is necessary to determine whether there is benefit to the use of any pharmacotherapy in the management of pediatric-aged athletes with concussions. PMID:26660460

  10. Mentoring practices benefiting pediatric nurses.

    PubMed

    Weese, Meghan M; Jakubik, Louise D; Eliades, Aris B; Huth, Jennifer J

    2015-01-01

    Previous studies examining predictors of pediatric nurse protégé mentoring benefits demonstrated that protégé perception of quality was the single best predictor of mentoring benefits. The ability to identify the mentoring practices that predict specific benefits for individual nurses provides a better understanding of how mentoring relationships can be leveraged within health care organizations promoting mutual mentoring benefits. This descriptive correlational, non-experimental study of nurses at a northeast Ohio, Magnet® recognized, free-standing pediatric hospital advances nursing science by demonstrating how mentoring practices benefit pediatric nurse protégés.

  11. Pediatric trauma: preparation and management.

    PubMed

    Brown, R C; Ioli, J G; Ferlise, M

    1993-01-01

    1. Trauma causes more than 50% of the deaths in children. The leading cause of pediatric injury is motor vehicle accidents involving children as passengers, pedestrians, or bicycle riders. 2. Trauma is always unexpected; therefore, the most vital aspect of any trauma system is that the system itself never be caught unprepared. Anticipation and preparation are the best first-line defenses against traumatic injury. 3. Because of a child's smaller size, vital organs are in close proximity to one another; multiple organ injuries are common. 4. The team who responds to a pediatric trauma should include nurses and physicians trained in principles of pediatric resuscitation.

  12. [Pediatric neurology and genetics: introduction].

    PubMed

    Castro-Gago, M

    Heredity plays a role in a large proportion of pediatric neurologic disorders, and the spectacular recent developments in molecular genetics have contributed to improved understanding of the basic causes of many diseases and neurodevelopmental abnormalities. To provide a brief introduction to certain genetic aspects of neuropediatrics. We consider the following aspects: 1) The importance of hereditary factors in pediatric neurology; 2) The different types of inheritance relevant in this context; 3) Nosologic, diagnostic and therapeutic implications of recent advances in molecular genetics; 4) Bioethical implications of the application of this new understanding. Independently of enhanced treatment prospects, progress in molecular genetics has improved the nosology and diagnosis of many pediatric neurological disorders.

  13. Radiation Safety in Pediatric Orthopaedics.

    PubMed

    Caird, Michelle S

    2015-01-01

    Patients, surgeons, and staff are exposed to ionizing radiation in pediatric orthopaedic surgery from diagnostic studies and imaging associated with procedures. Estimating radiation dose to pediatric patients is based on complex algorithms and dose to surgeons and staff is based on dosimeter monitoring. Surgeons can decrease radiation exposure to patients with careful and thoughtful ordering of diagnostic studies and by minimizing exposure intraoperatively. Surgeon and staff radiation exposure can be minimized with educational programs, proper shielding and positioning intraoperatively, and prudent use of intraoperative imaging. Overall, better awareness among pediatric orthopaedic surgeons of our role in radiation exposure can lead to improvements in radiation safety.

  14. Pediatric trampoline injuries.

    PubMed

    Hurson, Conor; Browne, Katherine; Callender, Orla; O'Donnell, Turlough; O'Neill, Anthony; Moore, David P; Fogarty, Esmond E; Dowling, Francis E

    2007-01-01

    The recreational use of trampolines has increased dramatically during the last 10 years. There has been a striking increase in the number of children presenting to fracture clinics with injuries associated with trampoline use. This increase in trampoline injuries has been reported in North America, but there has been a paucity of research in this area in Europe. We prospectively recorded details of patients presenting to our institution, Our Lady's Children's Hospital, Crumlin (Dublin, Ireland), during the busy summer months of June, July, and August 2005. Details recorded included type and mechanism of injury, the mode of referral, treatment, inpatient days, outpatient visits, specific details relating to trampoline safety, and an analysis of the cost of medical care. There were 101 patients treated for trampoline-related injuries in 3 months from June to August 2005. This represented 1.5% of the total attendances to the emergency department. The average age was 8.5 years (range, 1.4-17.4 years). There were 55 fractures, 38 soft tissue injuries, 5 head injuries, and 5 neck injuries, with an average Pediatric Trauma Score of 11.4. Fifty seven percent (58/101) of patients were on the trampoline with at least 1 other person. Twenty patients (19.8%) were admitted to hospital requiring 71 inpatient days. Twelve patients were treated in theatre. There were 163 fracture clinic visits, 212 x-rays, and 2 magnetic resonance imaging scans. Trampolines are a high-risk activity with the potential for significant orthopaedic injury. In Ireland, we have recently seen a dramatic increase in pediatric trampoline-related injuries mirroring the trend in the United States during the last 10 to 15 years. We found that more than 1 individual on a trampoline is a major risk factor for injury, where the lightest person is 14 times more likely to be injured than the heavier. The lighter person also has a greater chance of being injured with smaller numbers on the trampoline. We reiterate

  15. Pediatric nonaortic arterial aneurysms.

    PubMed

    Davis, Frank M; Eliason, Jonathan L; Ganesh, Santhi K; Blatt, Neal B; Stanley, James C; Coleman, Dawn M

    2016-02-01

    Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in

  16. Genomic landscape of pediatric adrenocortical tumors

    PubMed Central

    Pinto, Emilia M.; Chen, Xiang; Easton, John; Finkelstein, David; Liu, Zhifa; Pounds, Stanley; Rodriguez-Galindo, Carlos; Lund, Troy C.; Mardis, Elaine R.; Wilson, Richard K.; Boggs, Kristy; Yergeau, Donald; Cheng, Jinjun; Mulder, Heather L.; Manne, Jayanthi; Jenkins, Jesse; Mastellaro, Maria J.; Figueiredo, Bonald C.; Dyer, Michael A.; Pappo, Alberto; Zhang, Jinghui; Downing, James R.; Ribeiro, Raul C.; Zambetti, Gerard P.

    2015-01-01

    Pediatric adrenocortical carcinoma is a rare malignancy with poor prognosis. Here we analyze 37 adrenocortical tumors (ACTs) by whole genome, whole exome and/or transcriptome sequencing. Most cases (91%) show loss of heterozygosity (LOH) of chromosome 11p, with uniform selection against the maternal chromosome. IGF2 on chromosome 11p is overexpressed in 100% of the tumors. TP53 mutations and chromosome 17 LOH with selection against wild-type TP53 are observed in 28 ACTs (76%). Chromosomes 11p and 17 undergo copy-neutral LOH early during tumorigenesis, suggesting tumor-driver events. Additional genetic alterations include recurrent somatic mutations in ATRX and CTNNB1 and integration of human herpesvirus-6 in chromosome 11p. A dismal outcome is predicted by concomitant TP53 and ATRX mutations and associated genomic abnormalities, including massive structural variations and frequent background mutations. Collectively, these findings demonstrate the nature, timing and potential prognostic significance of key genetic alterations in pediatric ACT and outline a hypothetical model of pediatric adrenocortical tumorigenesis. PMID:25743702

  17. Bone Canopies in Pediatric Renal Osteodystrophy.

    PubMed

    Pereira, Renata C; Andersen, Thomas L; Friedman, Peter A; Tumber, Navdeep; Salusky, Isidro B; Wesseling-Perry, Katherine

    2016-01-01

    Pediatric renal osteodystrophy (ROD) is characterized by changes in bone turnover, mineralization, and volume that are brought about by alterations in bone resorption and formation. The resorptive and formative surfaces on the cancellous bone are separated from the marrow cavity by canopies consisting of a layer of flat osteoblastic cells. These canopies have been suggested to play a key role in the recruitment of osteoprogenitors during the process of bone remodeling. This study was performed to address the characteristics of the canopies above bone formation and resorption sites and their association with biochemical and bone histomorphometric parameters in 106 pediatric chronic kidney disease (CKD) patients (stage 2-5) across the spectrum of ROD. Canopies in CKD patients often appeared as thickened multilayered canopies, similar to previous reports in patients with primary hyperparathyroidism. This finding contrasts with the thin appearance reported in healthy individuals with normal kidney function. Furthermore, canopies in pediatric CKD patients showed immunoreactivity to the PTH receptor (PTHR1) as well as to the receptor activator of nuclear factor kappa-B ligand (RANKL). The number of surfaces with visible canopy coverage was associated with plasma parathyroid hormone (PTH) levels, bone formation rate, and the extent of remodeling surfaces. Collectively, these data support the conclusion that canopies respond to the elevated PTH levels in CKD and that they possess the molecular machinery necessary to respond to PTH signaling.

  18. Bone Canopies in Pediatric Renal Osteodystrophy

    PubMed Central

    Pereira, Renata C.; Andersen, Thomas L.; Friedman, Peter A.; Tumber, Navdeep; Salusky, Isidro B.; Wesseling-Perry, Katherine

    2016-01-01

    Pediatric renal osteodystrophy (ROD) is characterized by changes in bone turnover, mineralization, and volume that are brought about by alterations in bone resorption and formation. The resorptive and formative surfaces on the cancellous bone are separated from the marrow cavity by canopies consisting of a layer of flat osteoblastic cells. These canopies have been suggested to play a key role in the recruitment of osteoprogenitors during the process of bone remodeling. This study was performed to address the characteristics of the canopies above bone formation and resorption sites and their association with biochemical and bone histomorphometric parameters in 106 pediatric chronic kidney disease (CKD) patients (stage 2–5) across the spectrum of ROD. Canopies in CKD patients often appeared as thickened multilayered canopies, similar to previous reports in patients with primary hyperparathyroidism. This finding contrasts with the thin appearance reported in healthy individuals with normal kidney function. Furthermore, canopies in pediatric CKD patients showed immunoreactivity to the PTH receptor (PTHR1) as well as to the receptor activator of nuclear factor kappa-B ligand (RANKL). The number of surfaces with visible canopy coverage was associated with plasma parathyroid hormone (PTH) levels, bone formation rate, and the extent of remodeling surfaces. Collectively, these data support the conclusion that canopies respond to the elevated PTH levels in CKD and that they possess the molecular machinery necessary to respond to PTH signaling. PMID:27045269

  19. Electrographic seizures in pediatric ICU patients

    PubMed Central

    Arndt, Daniel H.; Carpenter, Jessica L.; Chapman, Kevin E.; Cornett, Karen M.; Gallentine, William B.; Giza, Christopher C.; Goldstein, Joshua L.; Hahn, Cecil D.; Lerner, Jason T.; Loddenkemper, Tobias; Matsumoto, Joyce H.; McBain, Kristin; Nash, Kendall B.; Payne, Eric; Sánchez, Sarah M.; Fernández, Iván Sánchez; Shults, Justine; Williams, Korwyn; Yang, Amy; Dlugos, Dennis J.

    2013-01-01

    Objectives: We aimed to determine the incidence of electrographic seizures in children in the pediatric intensive care unit who underwent EEG monitoring, risk factors for electrographic seizures, and whether electrographic seizures were associated with increased odds of mortality. Methods: Eleven sites in North America retrospectively reviewed a total of 550 consecutive children in pediatric intensive care units who underwent EEG monitoring. We collected data on demographics, diagnoses, clinical seizures, mental status at EEG onset, EEG background, interictal epileptiform discharges, electrographic seizures, intensive care unit length of stay, and in-hospital mortality. Results: Electrographic seizures occurred in 162 of 550 subjects (30%), of which 61 subjects (38%) had electrographic status epilepticus. Electrographic seizures were exclusively subclinical in 59 of 162 subjects (36%). A multivariable logistic regression model showed that independent risk factors for electrographic seizures included younger age, clinical seizures prior to EEG monitoring, an abnormal initial EEG background, interictal epileptiform discharges, and a diagnosis of epilepsy. Subjects with electrographic status epilepticus had greater odds of in-hospital death, even after adjusting for EEG background and neurologic diagnosis category. Conclusions: Electrographic seizures are common among children in the pediatric intensive care unit, particularly those with specific risk factors. Electrographic status epilepticus occurs in more than one-third of children with electrographic seizures and is associated with higher in-hospital mortality. PMID:23794680

  20. Decreased Cerebral Blood Flow in Chronic Pediatric Mild TBI: An MRI Perfusion Study

    PubMed Central

    Wang, Yang; West, John D.; Bailey, Jessica N.; Westfall, Daniel R.; Xiao, Hui; Arnold, Todd W.; Kersey, Patrick A.; Saykin, Andrew J.; McDonald, Brenna C.

    2015-01-01

    We evaluated cerebral blood flow (CBF) in chronic pediatric mild traumatic brain injury (mTBI) using arterial spin labeling (ASL) magnetic resonance imaging perfusion. mTBI patients showed lower CBF than controls in bilateral frontotemporal regions, with no between-group cognitive differences. Findings suggest ASL may be useful to assess functional abnormalities in pediatric mTBI. PMID:25649779

  1. The Utility of Chromosomal Microarray Analysis in Developmental and Behavioral Pediatrics

    ERIC Educational Resources Information Center

    Beaudet, Arthur L.

    2013-01-01

    Chromosomal microarray analysis (CMA) has emerged as a powerful new tool to identify genomic abnormalities associated with a wide range of developmental disabilities including congenital malformations, cognitive impairment, and behavioral abnormalities. CMA includes array comparative genomic hybridization (CGH) and single nucleotide polymorphism…

  2. The Utility of Chromosomal Microarray Analysis in Developmental and Behavioral Pediatrics

    ERIC Educational Resources Information Center

    Beaudet, Arthur L.

    2013-01-01

    Chromosomal microarray analysis (CMA) has emerged as a powerful new tool to identify genomic abnormalities associated with a wide range of developmental disabilities including congenital malformations, cognitive impairment, and behavioral abnormalities. CMA includes array comparative genomic hybridization (CGH) and single nucleotide polymorphism…

  3. Describing pediatric dysphonia with nonlinear dynamic parameters.

    PubMed

    Meredith, Morgan L; Theis, Shannon M; McMurray, J Scott; Zhang, Yu; Jiang, Jack J

    2008-12-01

    Nonlinear dynamic analysis has emerged as a reliable and objective tool for assessing voice disorders. However, it has only been tested on adult populations. In the present study, nonlinear dynamic analysis was applied to normal and dysphonic pediatric populations with the goal of collecting normative data. Jitter analysis was also applied in order to compare nonlinear dynamic and perturbation measures. This study's findings will be useful in creating standards for the use of nonlinear dynamic analysis as a tool to describe dysphonia in the pediatric population. The study included 38 pediatric subjects (23 children with dysphonia and 15 without). Recordings of sustained vowels were obtained from each subject and underwent nonlinear dynamic analysis and percent jitter analysis. The resulting correlation dimension (D2) and percent jitter values were compared across the two groups using t-tests set at a significance level of p=0.05. It was shown that D2 values covary with the presence of pathology in children. D2 values were significantly higher in dysphonic children than in normal children (p=0.002). Standard deviations indicated a higher level of variation in normal children's D2 values than in dysphonic children's D2 values. Jitter analysis showed markedly higher percent jitter in dysphonic children than in normal children (p=0.025) and large standard deviations for both groups. This study indicates that nonlinear dynamic analysis could be a viable tool for the detection and assessment of dysphonia in children. Further investigations and more normative data are needed to create standards for using nonlinear dynamic parameters for the clinical evaluation of pediatric dysphonia.

  4. Describing pediatric dysphonia with nonlinear dynamic parameters

    PubMed Central

    Meredith, Morgan L.; Theis, Shannon M.; McMurray, J. Scott; Zhang, Yu; Jiang, Jack J.

    2008-01-01

    Objective Nonlinear dynamic analysis has emerged as a reliable and objective tool for assessing voice disorders. However, it has only been tested on adult populations. In the present study, nonlinear dynamic analysis was applied to normal and dysphonic pediatric populations with the goal of collecting normative data. Jitter analysis was also applied in order to compare nonlinear dynamic and perturbation measures. This study’s findings will be useful in creating standards for the use of nonlinear dynamic analysis as a tool to describe dysphonia in the pediatric population. Methods The study included 38 pediatric subjects (23 children with dysphonia and 15 without). Recordings of sustained vowels were obtained from each subject and underwent nonlinear dynamic analysis and percent jitter analysis. The resulting correlation dimension (D2) and percent jitter values were compared across the two groups using t-tests set at a significance level of p = 0.05. Results It was shown that D2 values covary with the presence of pathology in children. D2 values were significantly higher in dysphonic children than in normal children (p = 0.002). Standard deviations indicated a higher level of variation in normal children’s D2 values than in dysphonic children’s D2 values. Jitter analysis showed markedly higher percent jitter in dysphonic children than in normal children (p = 0.025) and large standard deviations for both groups. Conclusion This study indicates that nonlinear dynamic analysis could be a viable tool for the detection and assessment of dysphonia in children. Further investigations and more normative data are needed to create standards for using nonlinear dynamic parameters for the clinical evaluation of pediatric dysphonia. PMID:18947887

  5. Pediatric Suprasellar Tumors.

    PubMed

    McCrea, Heather J; George, Emilie; Settler, Allison; Schwartz, Theodore H; Greenfield, Jeffrey P

    2016-10-01

    The various childhood suprasellar tumors, while pathologically distinct, present similar clinical and surgical challenges as a result of their common anatomic location. These lesions are in close proximity to or may invade the optic nerve and chiasm, pituitary gland and infundibulum, hypothalamus, and third ventricle, leading to presenting features including visual field loss, impairment in visual acuity, endocrine dysfunction, and hydrocephalus. Though many suprasellar lesions are relatively benign in pathology, treatment may be complicated by high surgical morbidity resulting from damage to the hypothalamic-pituitary axis. Here we review the most frequent pediatric lesions occurring in the suprasellar region: craniopharyngioma, chiasmatic glioma, germ cell tumor, Rathke cleft and arachnoid cysts, pituitary adenoma, and histiocytosis. This review outlines both common presenting features and differentiating aspects of these lesions. It also includes classic radiographic presentations and treatment considerations for each lesion.

  6. Introduction to Pediatric Sepsis.

    PubMed

    Wheeler, Derek S

    2011-10-07

    Sepsis is a significant health problem in both critically ill children and adults. While the mortality rate from sepsis is much lower in children, sepsis is directly responsible for over 4,000 childhood deaths per year in the United States alone. At face value, this number suggests that more children die per year in the United States from sepsis as the primary cause than from cancer. Unfortunately, there are few studies on the epidemiology, pathophysiology, and management of sepsis in children. Moreover, extrapolation of adult data to critically ill children is probably not appropriate due to several key developmental differences in the host response to infection and response to therapy. Therefore, additional studies targeting sepsis in the pediatric population are urgently required.

  7. Pediatric anthrax clinical management.

    PubMed

    Bradley, John S; Peacock, Georgina; Krug, Steven E; Bower, William A; Cohn, Amanda C; Meaney-Delman, Dana; Pavia, Andrew T

    2014-05-01

    Anthrax is a zoonotic disease caused by Bacillus anthracis, which has multiple routes of infection in humans, manifesting in different initial presentations of disease. Because B anthracis has the potential to be used as a biological weapon and can rapidly progress to systemic anthrax with high mortality in those who are exposed and untreated, clinical guidance that can be quickly implemented must be in place before any intentional release of the agent. This document provides clinical guidance for the prophylaxis and treatment of neonates, infants, children, adolescents, and young adults up to the age of 21 (referred to as "children") in the event of a deliberate B anthracis release and offers guidance in areas where the unique characteristics of children dictate a different clinical recommendation from adults. Copyright © 2014 by the American Academy of Pediatrics.

  8. Pediatric Posttraumatic Headache.

    PubMed

    Kacperski, Joanne; Hung, Ryan; Blume, Heidi K

    2016-02-01

    Concussion and mild traumatic brain injury are common injuries in pediatrics, and posttraumatic headache is the most common complaint following them. Although most children and teens recover from a simple, isolated concussion without incidents within 1-2 weeks, some develop symptoms that can last for months. It is important to manage both acute and persistent posttraumatic headaches appropriately to speed recovery, minimize disability, and maximize function. In this article, we review the definitions, epidemiology, and current recommendations for the evaluation and treatment of acute and persistent posttraumatic headaches. Although this is still a developing field and there is much that we still need to learn about concussion and the best strategies to prevent and treat these injuries and their sequelae, we hope that this review will help providers to understand the current evidence and treatment recommendations to improve care for children with concussion and mild traumatic brain injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Music therapy in pediatrics.

    PubMed

    Avers, Laura; Mathur, Ambika; Kamat, Deepak

    2007-09-01

    The soothing effects of music have been well described over the centuries and across cultures. In more recent times, studies have shown the beneficial effects of music in alleviating symptoms in a wide variety of clinical and psychologic conditions. Music therapy has been primarily used as an intervention to control emotional states, in pain management, cognitive processing, and stress management. Stress is associated with increased production of the stress hormone cortisol, which is known to suppress immune responses. Several studies in the past few decades have demonstrated a positive effect of music therapy on reducing stress or increasing immune responses, or both. Music therapy should therefore be considered as a valuable addition to standard pharmacologic therapeutic modalities in enhancing the immune response and lowering stress levels in such conditions. This article reviews the role of music as a therapeutic modality and the future for music therapy, particularly in pediatrics.

  10. Management of pediatric trauma.

    PubMed

    Krug, Steven E; Tuggle, David W

    2008-04-01

    Injury is the number 1 killer of children in the United States. In 2004, injury accounted for 59.5% of all deaths in children younger than 18 years. The financial burden to society of children who survive childhood injury with disability continues to be enormous. The entire process of managing childhood injury is complex and varies by region. Only the comprehensive cooperation of a broadly diverse group of people will have a significant effect on improving the care and outcome of injured children. This statement has been endorsed by the American Association of Critical-Care Nurses, American College of Emergency Physicians, American College of Surgeons, American Pediatric Surgical Association, National Association of Children's Hospitals and Related Institutions, National Association of State EMS Officials, and Society of Critical Care Medicine.

  11. Contemporary pediatric gynecologic imaging.

    PubMed

    Servaes, Sabah; Victoria, Teresa; Lovrenski, Jovan; Epelman, Monica

    2010-04-01

    Ultrasound is the primary screening modality for the evaluation of pediatric gynecologic maladies. Magnetic resonance imaging (MRI) is used progressively more in this field, particularly for the evaluation of complex pelvic masses and congenital anomalies. However, ultrasound remains the preferred modality due to the excellent visualization, the dynamic nature of the examination modality, lack of ionizing radiation and sedation risks, and comparatively lower cost. MRI is generally a second-line examination and is preferred over computed tomography as it does not involve the use of ionizing radiation. Additionally, visualization of the female reproductive system anatomy with MRI is superior to computed tomography, the latter being reserved generally for tumor staging. Fluoroscopic examinations and abdominal radiographs can provide additional information that may support a diagnosis. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. [Pediatric multiple trauma].

    PubMed

    Auner, B; Marzi, I

    2014-05-01

    Multiple trauma in children is rare so that even large trauma centers will only treat a small number of cases. Nevertheless, accidents are the most common cause of death in childhood whereby the causes are mostly traffic accidents and falls. Head trauma is the most common form of injury and the degree of severity is mostly decisive for the prognosis. Knowledge on possible causes of injury and injury patterns as well as consideration of anatomical and physiological characteristics are of great importance for treatment. The differences compared to adults are greater the younger the child is. Decompression and stopping bleeding are the main priorities before surgical fracture stabilization. The treatment of a severely injured child should be carried out by an interdisciplinary team in an approved trauma center with expertise in pediatrics. An inadequate primary assessment involves a high risk of early mortality. On the other hand children have a better prognosis than adults with comparable injuries.

  13. Pediatric Headache: An Overview.

    PubMed

    Langdon, Raquel; DiSabella, Marc T

    2017-03-01

    Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. In this article, we take a holistic approach to the child presenting with headache with a focus on the detailed headache history, physical and neurologic examinations, and diagnostic evaluation of these patients. Clinical presentations and classification schema of multiple primary and secondary headache types in children are discussed using the International Headache Criteria (IHCD-3) as a guide, and a summary provided of the various treatment modalities employed for pediatric headache including lifestyle modifications, behavioral techniques, and abortive and preventive medications. Copyright © 2017 Mosby, Inc. All rights reserved.

  14. Pediatric radiation oncology

    SciTech Connect

    Halperin, E.C.; Kun, L.E.; Constine, L.S.; Tarbell, N.J.

    1989-01-01

    This text covers all aspects of radiation therapy for treatment of pediatric cancer. The book describes the proper use of irradiation in each of the malignancies of childhood, including tumors that are rarely encountered in adult practice. These include acute leukemia; supratentorial brain tumors; tumors of the posterior fossa of the brain and spinal canal; retinoblastoma and optic nerve glioma; neuroblastoma; Hodgkin's disease; malignant lymphoma; Ewing's sarcoma; osteosarcoma; rhabdomyosarcoma; Desmoid tumor; Wilms' tumor; liver and biliary tumors; germ cell and stromal cell tumors of the gonads; endocrine, aerodigestive tract, and breast tumors; Langerhans' cell histiocytosis; and skin cancer and hemangiomas. For each type of malignancy, the authors describe the epidemiology, common presenting signs and symptoms, staging, and proper diagnostic workup. Particular attention is given to the indications for radiation therapy and the planning of a course of radiotherapy, including the optimal radiation dose, field size, and technique.

  15. Modified pediatric end-stage liver disease scoring system and pediatric liver transplantation in Brazil.

    PubMed

    Neto, Joao Seda; Carone, Eduardo; Pugliese, Renata P S; Fonseca, Eduardo A; Porta, Gilda; Miura, Irene; Danesi, Vera B; Guimaraes, Teresa C; Godoy, Andre L; Porta, Adriana; Vincenzi, Rodrigo; Carnevale, Francisco; Kondo, Mario; Chapchap, Paulo

    2010-04-01

    The Pediatric End-Stage Liver Disease (PELD) scoring system is a formula developed to provide a continuous numerical assessment of the risk of death in order to allocate livers to children in need of transplantation. The PELD scoring system was introduced in Brazil in July 2006. An important change was made in the system: the final number for listing patients less than 12 years old for transplantation was the calculated PELD score multiplied by 3. The consequences of this allocation policy were analyzed in 2 ways in this research: nationally and in the state of São Paulo (SP State). In the analysis of the national data, a comparison of the pre-PELD era (July 2003 to July 2006) and the post-PELD era (August 2006 to April 2009) showed that the total number of pediatric transplants for children under 12 years of age decreased 7%. Regionally, in SP State, there was a 62% increase in the number of deceased donor liver transplantation procedures for the pediatric population after the introduction of the modified PELD system. There was also a 6.1-fold increase in split liver transplantation as well as a statistically significant decrease in the time on the waiting list (P < 0.001). In conclusion, changing the allocation policy in Brazil in order to benefit pediatric patients on the waiting list had different results according to analyses of national and regional data. A significant increase in deceased donor liver transplantation/split liver transplantation and a shorter time on the waiting list were observed in SP State. The modified PELD scoring system is simple and optimizes the utilization of deceased donor liver grafts in centers performing pediatric transplants. (c) 2010 AASLD

  16. Genetics of pediatric obesity.

    PubMed

    Manco, Melania; Dallapiccola, Bruno

    2012-07-01

    Onset of obesity has been anticipated at earlier ages, and prevalence has dramatically increased worldwide over the past decades. Epidemic obesity is mainly attributable to modern lifestyle, but family studies prove the significant role of genes in the individual's predisposition to obesity. Advances in genotyping technologies have raised great hope and expectations that genetic testing will pave the way to personalized medicine and that complex traits such as obesity will be prevented even before birth. In the presence of the pressing offer of direct-to-consumer genetic testing services from private companies to estimate the individual's risk for complex phenotypes including obesity, the present review offers pediatricians an update of the state of the art on genomics obesity in childhood. Discrepancies with respect to genomics of adult obesity are discussed. After an appraisal of findings from genome-wide association studies in pediatric populations, the rare variant-common disease hypothesis, the theoretical soil for next-generation sequencing techniques, is discussed as opposite to the common disease-common variant hypothesis. Next-generation sequencing techniques are expected to fill the gap of "missing heritability" of obesity, identifying rare variants associated with the trait and clarifying the role of epigenetics in its heritability. Pediatric obesity emerges as a complex phenotype, modulated by unique gene-environment interactions that occur in periods of life and are "permissive" for the programming of adult obesity. With the advent of next-generation sequencing techniques and advances in the field of exposomics, sensitive and specific tools to predict the obesity risk as early as possible are the challenge for the next decade.

  17. EUS in pediatric patients.

    PubMed

    Attila, Tan; Adler, Douglas G; Hilden, Kristen; Faigel, Douglas O

    2009-11-01

    The knowledge of EUS use in children is limited. We investigated the indications, feasibility, safety, and clinical utility of EUS in the management of pediatric GI, pancreatobiliary, and mediastinal diseases. Retrospective study. Two tertiary referral university hospitals. Consecutive children age younger than 18 years referred over a 7-year period for EUS evaluation. Forty EUS scans were performed in 38 children with a mean age of 13.5 years. The indications for pancreatobiliary endosonography were pancreatitis (n = 10), solid pancreatic mass (n = 7), cystic pancreatic mass (n = 1), cyst in the setting of chronic pancreatitis (n = 1), suspected annular pancreas (n = 1), celiac plexus block (n = 1), suspected common bile duct stone (n = 1), abdominal pain and atrophic pancreas (n = 1), ampullary adenoma (n = 1), and abnormal MRCP in a patient with jaundice (n = 1). The indications for gastric EUS were mucosal lesions (n = 2) and subepithelial lesions (n = 4). The indications for mediastinal endosonography were mediastinal masses/lymph nodes (n = 5). The remaining evaluations were performed for esophageal stricture (n = 1), unexplained abdominal pain (n = 1), unexplained abdominal pain with celiac axis block (n = 1), and perirectal fluid collection (n = 1). EUS-guided FNA (EUS-FNA) was performed in 12 (30%) cases and established the correct diagnosis in 9 (75%). EUS-guided fine-needle injections for celiac axis block were performed in 2 (5%) cases. The procedure was successful in all patients, and no complications related to sedation, EUS, or EUS-FNA were encountered. Retrospective study. EUS and EUS-FNA are feasible and safe and have a significant impact on the management of pediatric GI, pancreatobiliary, and mediastinal diseases.

  18. Advances in pediatrics. Volume 32

    SciTech Connect

    Barness, L.A.

    1985-01-01

    These proceedings collect papers on pediatrics. Topics include: the biological role and clinical implications of taurine; human milk nonprotein nitrogen; monoclonal antibodies in the diagnosis and treatment of childhood diseases; and human immune responses to polysaccharide antigens.

  19. Childhood obesity for pediatric gastroenterologists.

    PubMed

    Huang, Jeannie S; Barlow, Sarah E; Quiros-Tejeira, Ruben E; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P; Xanthakos, Stavra A

    2013-01-01

    Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology.

  20. Stress in pediatric oncology nurses.

    PubMed

    Hecktman, Hillary Michelle

    2012-01-01

    Although the onset of physiological and emotional stress can greatly affect outcomes for a child with cancer, the focus of this review targets pediatric oncology nurses and their daily occupation-related stress. Literature currently exists that discusses the etiology of stress in the oncology work environment as well as coping strategies and their effects on pediatric oncology nurses' stress levels. To date, however, no literature review has been assembled to comprehensively address practice implications and provide recommendations for pediatric oncology staff nurses. This review of literature seeks to provide a general overview of stress experienced in the pediatric oncology work environment and supportive interventions to decrease negative outcomes such as compassion fatigue and burnout. Recommendations and conclusions are made based on existing interventions, thus creating a framework for future research to be conducted to compare the effectiveness of these measures and optimize patient experiences through caregiver well-being.

  1. What Is a Pediatric Urologist?

    MedlinePlus

    ... Family Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  2. What Is a Pediatric Rheumatologist?

    MedlinePlus

    ... centers, and large community hospitals. Pediatric Rheumatologists – The Best Care For Children Children are not just small ... gain the child’s confidence and cooperation to the best of the child’s developmental abilities. If your pediatrician ...

  3. Recent advances in pediatric echocardiography.

    PubMed

    Bharucha, Tara; Mertens, Luc

    2013-01-01

    Echocardiography is the fundamental tool in the management of children with congenital heart disease (CHD), and cross-sectional echocardiography is still the main technique used for diagnosis and therapeutic planning. Recent advances in pediatric echocardiography include 3D echocardiography and functional imaging. The recent development of specific pediatric probes allows imaging of pediatric hearts with high temporal and spatial resolution. Lesions are often anatomically complex, and 3D echocardiography allows increased appreciation of complex spatial relationships and can thereby be valuable in understanding functional anatomy and planning interventions. Assessment of pediatric myocardial function can be difficult, with highly variable ventricular morphology. Assessment of right ventricular function and function of the single ventricle are current challenges in CHD. The introduction of myocardial tissue Doppler velocities and deformation imaging (strain and strain-rate quantification) facilitates the quantification of myocardial function independent of underlying morphology. These techniques offer new insights into the mechanics of CHD.

  4. Nutrition for the pediatric athlete.

    PubMed

    Unnithan, Viswanath B; Goulopoulou, Styliani

    2004-08-01

    A paucity of literature exists with regard to research on nutrition for the pediatric athlete. This lack of research makes the development of specific nutritional recommendations for young athletes problematic. This issue is made difficult by the macro- and micronutrient intake required for growth and development in conjunction with that required for sports. Exogenous carbohydrate drinks could be considered for the young athlete engaged in both endurance exercise and high-intensity exercise. Monitoring of the energy intake during resistance training in the pediatric athlete needs to be considered, as there is evidence to suggest that energy deficits may occur. If decrements in exercise performance are noted, then serum ferritin and hemoglobin concentrations should be monitored, as nonanemic iron deficiency is prevalent in the pediatric athlete. The pediatric athlete exercising in the heat is susceptible to voluntary dehydration and evidence exists to suggest that a carbohydrate-electrolyte drink will abolish this phenomenon.

  5. Complications in Pediatric Facial Fractures

    PubMed Central

    Chao, Mimi T.; Losee, Joseph E.

    2009-01-01

    Despite recent advances in the diagnosis, treatment, and prevention of pediatric facial fractures, little has been published on the complications of these fractures. The existing literature is highly variable regarding both the definition and the reporting of adverse events. Although the incidence of pediatric facial fractures is relative low, they are strongly associated with other serious injuries. Both the fractures and their treatment may have long-term consequence on growth and development of the immature face. This article is a selective review of the literature on facial fracture complications with special emphasis on the complications unique to pediatric patients. We also present our classification system to evaluate adverse outcomes associated with pediatric facial fractures. Prospective, long-term studies are needed to fully understand and appreciate the complexity of treating children with facial fractures and determining the true incidence, subsequent growth, and nature of their complications. PMID:22110803

  6. Pediatric Ingestions: Emergency Department Management.

    PubMed

    Tarango Md, Stacy M; Liu Md, Deborah R

    2016-04-01

    Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments with concern for unintentional medication exposure, and nearly half of all calls to poison centers are for children aged less than 6 years. Ingestion of magnetic objects and button batteries has also become an increasing source of morbidity and mortality. Although fatal pediatric ingestions are rare, the prescription medications most responsible for injury and fatality in children include opioids, sedative/hypnotics, and cardiovascular drugs. Evidence regarding the evaluation and management of common pediatric ingestions is comprised largely of case reports and retrospective studies. This issue provides a review of these studies as well as consensus guidelines addressing the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination, administration of antidotes for specific toxins, and management of ingested foreign bodies.

  7. Update on pediatric photosensitivity disorders.

    PubMed

    Grossberg, Anna L

    2013-08-01

    Although rare in the pediatric population, photosensitive dermatoses may begin prior to adulthood. The causes of photosensitivity are diverse, ranging from primary, immunologically mediated disorders of photosensitivity to inherited genetic or metabolic disorders. This review will highlight the key features of these disorders to familiarize the pediatric practitioner with their symptoms and any associated extracutaneous clinical or laboratory findings that may accompany them. New developments in the field of pediatric photosensitivity have been scant over recent years. While mechanisms of photosensitivity and genetic underpinnings associated with various conditions such as xeroderma pigmentosum continue to be uncovered, the literature on disorders of photosensitivity has been otherwise without many recent significant advances. Although the differential diagnosis of pediatric photosensitivity disorders is broad, it is often possible to establish the diagnosis by following an algorithmic approach. Once the correct diagnosis is rendered, this will guide any further workup that needs to be performed as well as specific management strategies.

  8. Childhood Obesity for Pediatric Gastroenterologists

    PubMed Central

    Huang, Jeannie S.; Barlow, Sarah E.; Quiros-Tejeira, Ruben E.; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P.; Xanthakos, Stavra A.

    2014-01-01

    Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology. PMID:23282941

  9. Pacific Pediatric Advanced Care Initiative

    DTIC Science & Technology

    2011-01-01

    blood bank, blood utilization committee, clinical laboratories, operating room, central supply, pharmacy, respiratory care, Neonatal Intensive Care...granted privileges to provide routine and emergency clinical care for infant patients on ECLS. This includes 12 Neonatal physicians and 6 Pediatric...Evaluation of the Avalon Elite Bi-caval Dual Lumen Catheter in Neonatal and Pediatric VV ECMO. ECMO and the Advanced Therapies for Respiratory Failure

  10. Innovation in pediatric surgical education.

    PubMed

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  11. Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

    PubMed

    Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

    2016-10-01

    OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1

  12. miRNA Expression in Pediatric Failing Human Heart

    PubMed Central

    Stauffer, Brian L.; Russell, Gloria; Nunley, Karin; Miyamoto, Shelley D.; Sucharov, Carmen C.

    2013-01-01

    miRNAs are short regulatory RNAs that can regulate gene expression through interacting with the 3'UTR of target mRNAs. Although the role of miRNAs has been extensively studied in adult human and animal models of heart disease, nothing is known about their expression in pediatric heart failure patients. Different than adults with heart failure, pediatric patients respond well to phosphodiesterase inhibitor (PDEi) treatment, which is safe in the outpatient setting, results in fewer heart failure emergency department visits, fewer cardiac hospital admissions and improved NYHA classification. We have recently shown that the pediatric heart failure patients display a unique molecular profile that is different from adults with heart failure. In this study we show for the first time that pediatric heart failure patients display a unique miRNA profile, and that expression of some miRNAs correlate with response to PDEi treatment. Moreover, we show that expression of Smad4, a potential target for PDEi-regulated miRNAs, is normalized in PDEi-treated patients. Since miRNAs may be used as therapy for human heart failure, our results underscore the importance of defining the molecular characteristics of pediatric heart failure patients, so age-appropriate therapy can be designed for this population. PMID:23333438

  13. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices

    PubMed Central

    Kapoor, Ashna; Indushekar, KR; Saraf, Bhavna G; Sheoran, Neha

    2016-01-01

    Introduction Dentifrices are available in different formulations and more commonly a single dentifrice is used by whole family; be it an adult or child. However, concerns over high fluoride in pediatric formulations coupled with inability of the children to spit have led to recommendations to minimize fluoride ingestion during toothbrushing by using a small amount of toothpaste by children and incorporating minimal quantity of fluoride in the toothpastes. Literature is scarce on the remineralization potential of popularly known Indian pediatric dentifrices; hence, pediatric dentifrices containing lesser concentration of fluoride have been marketed relatively recently for the benefit of children without posing a threat of chronic fluoride toxicity at the same time. Aim and objectives The present study was undertaken to evaluate and compare the remineralization potential of three commercially available Indian pediatric dentifrices with different compositions on artificially induced carious lesions in vitro through scanning electron microscopy (SEM). Materials and methods The present in vitro study was conducted on 45 sound extracted primary molar surfaces divided into three groups (15 each). Artificial demineralization was carried out, followed by remineralization using dentifrice slurry as per the group allocation. All the samples were studied for remineralization using SEM and the results statistically compared. Results All three dentifrices tested showed remineralization; although insignificantly different from each other but significantly higher compared to the demineralizing surface. Conclusion One can use pediatric dentifrices for preventing dental caries and decelerating lesion progression with an added advantage of lower fluoride toxicity risk. How to cite this article Kapoor A, Indushekar KR, Saraf BG, Sheoran N, Sardana D. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices. Int J Clin Pediatr Dent 2016;9(3):186-191. PMID

  14. Air pollution, temperature and pediatric influenza in Brisbane, Australia.

    PubMed

    Xu, Zhiwei; Hu, Wenbiao; Williams, Gail; Clements, Archie C A; Kan, Haidong; Tong, Shilu

    2013-09-01

    Previous studies have demonstrated the importance of weather variables in influencing the incidence of influenza. However, the role of air pollution is often ignored in identifying the environmental drivers of influenza. This research aims to examine the impacts of air pollutants and temperature on the incidence of pediatric influenza in Brisbane, Australia. Lab-confirmed daily data on influenza counts among children aged 0-14years in Brisbane from 2001 January 1st to 2008 December 31st were retrieved from Queensland Health. Daily data on maximum and minimum temperatures for the same period were supplied by the Australian Bureau of Meteorology. Winter was chosen as the main study season due to it having the highest pediatric influenza incidence. Four Poisson log-linear regression models, with daily pediatric seasonal influenza counts as the outcome, were used to examine the impacts of air pollutants (i.e., ozone (O3), particulate matter≤10μm (PM10) and nitrogen dioxide (NO2)) and temperature (using a moving average of ten days for these variables) on pediatric influenza. The results show that mean temperature (Relative risk (RR): 0.86; 95% Confidence Interval (CI): 0.82-0.89) was negatively associated with pediatric seasonal influenza in Brisbane, and high concentrations of O3 (RR: 1.28; 95% CI: 1.25-1.31) and PM10 (RR: 1.11; 95% CI: 1.10-1.13) were associated with more pediatric influenza cases. There was a significant interaction effect (RR: 0.94; 95% CI: 0.93-0.95) between PM10 and mean temperature on pediatric influenza. Adding the interaction term between mean temperature and PM10 substantially improved the model fit. This study provides evidence that PM10 needs to be taken into account when evaluating the temperature-influenza relationship. O3 was also an important predictor, independent of temperature. © 2013 Elsevier Ltd. All rights reserved.

  15. Pediatric Nasopharyngeal Cancer: Case Report and Review of the Literature.

    PubMed

    González-Motta, Alejandro; González, Garvin; Bermudéz, Yurany; Maldonado, Maria C; Castañeda, Javier M; Lopéz, David; Cotes-Mestre, Martha

    2016-02-15

    Pediatric nasopharyngeal carcinoma, also referred to as cavum carcinoma, is a rare pediatric disease with an infrequent incidence rate. We present the case of a pediatric patient with nasopharyngeal cancer who received an adult schedule of concomitant chemotherapy and conformal radiotherapy with a brachytherapy boost. Adult protocols with high radiotherapy doses are not commonly used in pediatric patients due to the high comorbidity associated with this practice. In this case, the patient displayed excellent overall survival, a longer disease-free period, and fewer side effects and comorbidities, even in the absence of interferon therapy, which is not easily available in low-income countries. In addition, this case shows that conformal radiotherapy and brachytherapy are options that can be used to escalate the radiotherapy dose and decrease side effects. A 12-year-old female pediatric patient presented to our outpatient clinic with an eight-month history of moderate-to-severe otalgia, intermittent hyaline rhinorrhea, asthenia, adynamia, nasal congestion, epistaxis in the previous months, and local pruritus. Upon physical examination, a 60x60 mm mass was detected at level II of the neck, and a biopsy of the lesion confirmed a histopathological diagnosis of undifferentiated carcinoma compatible with nasopharyngeal carcinoma. The patient was considered to have clinical Stage III cancer, and she received an adult Al-Sarraf protocol with chemoradiotherapy and an intracavitary brachytherapy boost. The patient had a complete response, and she remains without local or distance relapse. Treating pediatric nasopharyngeal carcinoma patients with the Al-Sarraf protocol could be a feasible modality, as observed in this clinical case, despite the elevated cost of using interferon-beta in low-income countries when using more advanced radiotherapy techniques such as conformal radiotherapy and now, modulated intensity radiotherapy. It should be noted that brachytherapy boosts

  16. Pediatric Nasopharyngeal Cancer: Case Report and Review of the Literature

    PubMed Central

    González, Garvin; Bermudéz, Yurany; Maldonado, Maria C; Castañeda, Javier M; Lopéz, David; Cotes-Mestre, Martha

    2016-01-01

    Pediatric nasopharyngeal carcinoma, also referred to as cavum carcinoma, is a rare pediatric disease with an infrequent incidence rate. We present the case of a pediatric patient with nasopharyngeal cancer who received an adult schedule of concomitant chemotherapy and conformal radiotherapy with a brachytherapy boost. Adult protocols with high radiotherapy doses are not commonly used in pediatric patients due to the high comorbidity associated with this practice. In this case, the patient displayed excellent overall survival, a longer disease-free period, and fewer side effects and comorbidities, even in the absence of interferon therapy, which is not easily available in low-income countries. In addition, this case shows that conformal radiotherapy and brachytherapy are options that can be used to escalate the radiotherapy dose and decrease side effects. A 12-year-old female pediatric patient presented to our outpatient clinic with an eight-month history of moderate-to-severe otalgia, intermittent hyaline rhinorrhea, asthenia, adynamia, nasal congestion, epistaxis in the previous months, and local pruritus. Upon physical examination, a 60x60 mm mass was detected at level II of the neck, and a biopsy of the lesion confirmed a histopathological diagnosis of undifferentiated carcinoma compatible with nasopharyngeal carcinoma. The patient was considered to have clinical Stage III cancer, and she received an adult Al-Sarraf protocol with chemoradiotherapy and an intracavitary brachytherapy boost. The patient had a complete response, and she remains without local or distance relapse. Treating pediatric nasopharyngeal carcinoma patients with the Al-Sarraf protocol could be a feasible modality, as observed in this clinical case, despite the elevated cost of using interferon-beta in low-income countries when using more advanced radiotherapy techniques such as conformal radiotherapy and now, modulated intensity radiotherapy. It should be noted that brachytherapy boosts

  17. Housing subsidies and pediatric undernutrition.

    PubMed

    Meyers, A; Frank, D A; Roos, N; Peterson, K E; Casey, V A; Cupples, L A; Levenson, S M

    1995-10-01

    To test the hypothesis that receipt of housing subsidies by poor families is associated with improved nutritional status of their children. Cross-sectional study. Pediatric emergency department of an urban municipal hospital. Convenience sample of 203 children younger than 3 years and their families who were being seen during one of twenty-seven 24-hour periods. Anthropometric indicators (z scores of weight for age, weight-for-height, and height-for-age), and the proportion of children with low growth indicator (weight-for-height below the 10th percentile or height-for-age below the fifth percentile, or both, of the reference population). Multivariate analysis controlling for demographics and program participation showed that receipt of housing assistance contributed significantly to z scores for weight-for-age (P = .03) and weight-for-height (P = .04). The risk of a child's having low growth indicators was 21.6% for children whose families were on the waiting list for housing assistance compared with 3.3% for those whose families received subsidies (adjusted odds ratio = 8.2, 95% confidence interval = 2.2 to 30.4, P = .002) Receiving a housing subsidy is associated with increased growth in children from low-income families, an effect that is consistent with a protective effect of housing subsidies against childhood undernutrition.

  18. Pediatric malignancies in Bursa, Turkey.

    PubMed

    Günay, U; Meral, A; Sevinir, B

    1996-01-01

    Turkey is among the countries affected by ionizing radiation from the Chernobyl accident of April 26, 1986. The northern part of Turkey, where the city of Bursa is located, is presumed to be more influenced by the nuclear catastrophe. The radioactive elements in the atmosphere have been examined at various intervals after May 1, 1986 and barium-140 and lanthanum-140, fission agents of uranium-235, have been found in the atmosphere. Their exact concentration could not be measured. The aim of this report is to review the pediatric malignancies diagnosed in our institution between 1986 and 1995, with a view on any significant increase in the number of these cases. The patients were divided into three groups: acute leukemia patients (101 cases), lymphomas (44 cases), and solid tumors (31 cases). All three groups showed a tendency to increase after 1986; the increase in leukemia cases between 1986 and 1995 was found to be significantly higher (p < 0.001) when compared with the years before 1986. The increase in lymphoma and solid tumor cases after 1986 was not found to be significant (p > 0.05). We cannot rule out environmental causes other than the effects of the Chernobyl accident, and we feel that more intense epidemiological studies should be carried out on this subject in other areas of Turkey.

  19. Helicobacter pylori Infection in Pediatrics.

    PubMed

    Roma, Eleftheria; Miele, Erasmo

    2015-09-01

    This review includes the main pediatric studies published from April 2014 to March 2015. The host response of Treg cells with increases in FOXP3 and TGF-β1 combined with a reduction in IFN-γ by Teff cells may contribute to Helicobacter pylori susceptibility in children. Genotypic variability in H. pylori strains influences the clinical manifestation of the infection. Helicobacter pylori infection is associated with variables indicative of a crowded environment and poor living conditions, while breast-feeding has a protective effect. Intrafamilial infection, especially from mother to children and from sibling to sibling, is the dominant transmission route. Studies showed conflicting results regarding the association between H. pylori infection and iron deficiency anemia. One study suggests that H. pylori eradication plays a role in the management of chronic immune thrombocytopenic purpura in H. pylori-infected children and adolescents. The prevalence of H. pylori was higher in chronic urticaria patients than in controls and, following H. pylori eradication, urticarial symptoms disappeared. An inverse relationship between H. pylori infection and allergic disease was reported. Antibiotic resistance and insufficient compliance to treatment limit the efficacy of eradication therapy. Sequential therapy had no advantage over standard triple therapy. In countries where H. pylori infection is prevalent, studies focusing on virulence factors and antibiotic susceptibility may provide anticipation of the prognosis and may be helpful to reduce morbidity and mortality.

  20. Pediatric radiology in oto-rhino-laryngology

    PubMed Central

    von Kalle, Thekla; Koitschev, Assen

    2014-01-01

    Head and neck diseases in children and adolescents present special diagnostic and differential diagnostic challenges to ENT surgeons as well as to radiologists. Both disciplines have to adapt the latest radiological and interventional technologies to the needs of the pediatric patient in order to enable a minimally invasive but successful diagnostic procedure. High quality sonography by an experienced examiner is often the only imaging technique that is necessary in children and adolescents. Radiographs are rarely indicated in pediatric head and neck diseases. MRI, compared to computed tomography, has the advantage of absent radiation exposure. Additionally, due to current advances in high resolution techniques to delineate very small details or in visualization of different tissue characteristics, it has become an integral part of pre- and postoperative imaging. However, children should not be denied an adequate diagnostic procedure even if it includes sedation, intervention, or exposure to radiation. The responsible use of the diagnostic options under consideration of the therapeutic consequences is essential. It is most likely to be successful in a close interdisciplinary cooperation of pediatric ENT specialists and radiologists as well as pediatric anesthesiologists in selected cases. Although benign diseases predominate in children and adolescents, the possibility of malignancy has to be considered in cases of atypical clinical and radiological findings. In many of these young patients, the outcome and the probability of survival are directly associated with the initial diagnostic and therapeutic strategies, which should therefore be in accordance with the current guidelines of pediatric oncology therapy studies. Our collection of clinical cases consists of representative examples of useful diagnostic approaches in common and age specific diagnoses as well as in rare diseases and malformations. It shows the significance of a special knowledge in embryology and

  1. [Pediatric residency programs in Latin America].

    PubMed

    Mendoza, H

    1991-01-01

    Prior to 1960 pediatric hospital residency programs were scarce in Latin America, but at present only one country lacks such a program. The first push for development of pediatric residency programs began in the 1960s and was aided by visits of Latin American medical professionals to the US under sponsorship of the Committee for Development of Pediatric Residency Programs (COPREP) of the American Academy of Pediatrics. COPREP meetings in Colombia in 1970 and in Brazil in 1975 coincided with a stage of accelerated progress in establishing and improving pediatric residency programs. After the 1975 meeting, COPREP activity declined, probably because of loss of financial support from the American Academy of Pediatrics. The Pediatric Residency Committee of the Latin American Pediatric Association (ALAPE) met in Santo Domingo in 1981 to approve an outline of objectives and activities, set minimum requirements for pediatric residency programs, and establish elements for quality control. The ALAPE Pediatric Residency Committee has also been greatly weakened since 1981, probably because of inadequate financial assistance and an overly ambitious program. The weakness of the Pediatric Residency Committees has impeded development of programs in Latin America. Pediatric residency programs in the region are heterogeneous in objectives and structure because of the differing national health structures in which they are embedded. Periodic exchanges of experience at the national and regional levels might help strengthen the pediatric residency programs.

  2. Clerkship curricular revision based on the Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics guidelines: does it make a difference?

    PubMed

    Kuo, A A; Slavin, S J

    1999-04-01

    To compare general pediatric knowledge acquisition and clinical problem-solving skills by students pre- and postcurricular reform based on the 1994 Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics (APA-COMSEP) curricular guidelines. A large, urban academic medical center. Third-year medical students on a required clerkship in Pediatrics. Pre- and postcurricular revision, the students were given both the National Board of Medical Examiners (NBME) Pediatric Subject Examination and an objective examination, which was developed in-house, based on the APA-COMSEP guidelines (Pediatric Clerkship Examination [PCE]). Baseline data before curricular revision were obtained on 52 students from May 1995 to May 1996. After curricular redesign in May 1996, data were obtained on 42 students from May 1996 to May 1997. Curricular revision focused on the following: defining educational principles, selecting teaching strategies, defining learning objectives, implementing the curriculum, and evaluating the students with an examination. Before curricular revision, the average NBME score was 521 +/- 122. The average PCE score was 53.7% +/- 10.1%. After curricular revision, the average NBME score was 520 +/- 109, and the average PCE score was 67.7% +/- 8.4%. Content areas showing the greatest improvement were fluids and electrolytes, issues pertaining to the newborn, and health supervision. Our baseline data indicate that despite spending two thirds of the clerkship in the ambulatory setting, students did not acquire adequate general pediatric knowledge or clinical problem-solving ability. After broad clerkship revision based on the APA-COMSEP Core Curriculum, students' acquisition of general pediatric knowledge and clinical problem-solving improved significantly, as measured by the PCE. The overall NBME Pediatric Subject Examination scores did not reflect this increased acquisition of general pediatric knowledge.

  3. The Geographic Distribution of Pediatric Anesthesiologists Relative to the US Pediatric Population.

    PubMed

    Muffly, Matthew K; Medeiros, David; Muffly, Tyler M; Singleton, Mark A; Honkanen, Anita

    2017-07-01

    The geographic relationship between pediatric anesthesiologists and the pediatric population has potentially important clinical and policy implications. In the current study, we describe the geographic distribution of pediatric anesthesiologists relative to the US pediatric population (0-17 years) and a subset of the pediatric population (0-4 years). The percentage of the US pediatric population that lives within different driving distances to the nearest pediatric anesthesiologist (0 to 25 miles, >25 to 50 miles, >50 to 100 miles, >100 to 250 miles, and >250 miles) was determined by creating concentric driving distance service areas surrounding pediatric anesthesiologist practice locations. US Census block groups were used to determine the sum pediatric population in each anesthesiologist driving distance service area. The pediatric anesthesiologist-to-pediatric population ratio was then determined for each of the 306 hospital referral regions (HRRs) in the United States and compared with ratios of other physician groups to the pediatric population. All geographic mapping and analysis was performed using ArcGIS Desktop 10.2.2 mapping software (Redlands, CA). A majority of the pediatric population (71.4%) lives within a 25-mile drive of a pediatric anesthesiologist; however, 10.2 million US children (0-17 years) live greater than 50 miles from the nearest pediatric anesthesiologist. More than 2.7 million children ages 0 to 4 years live greater than 50 miles from the nearest identified pediatric anesthesiologist. The median ratio of pediatric anesthesiologists to 100,000 pediatric population at the HRR level was 2.25 (interquartile range, 0-5.46). Pediatric anesthesiologist geographic distribution relative to the pediatric population by HRR is lower and less uniform than for all anesthesiologists, neonatologists, and pediatricians. A substantial proportion of the US pediatric population lives greater than 50 miles from the nearest pediatric anesthesiologist, and

  4. Missed Nursing Care in Pediatrics.

    PubMed

    Lake, Eileen T; de Cordova, Pamela B; Barton, Sharon; Singh, Shweta; Agosto, Paula D; Ely, Beth; Roberts, Kathryn E; Aiken, Linda H

    2017-07-01

    A growing literature suggests that missed nursing care is common in hospitals and may contribute to poor patient outcomes. There has been scant empirical evidence in pediatric populations. Our objectives were to describe the frequency and patterns of missed nursing care in inpatient pediatric settings and to determine whether missed nursing care is associated with unfavorable work environments and high nurse workloads. A cross-sectional study using registered nurse survey data from 2006 to 2008 was conducted. Data from 2187 NICU, PICU, and general pediatric nurses in 223 hospitals in 4 US states were analyzed. For 12 nursing activities, nurses reported about necessary activities that were not done on their last shift because of time constraints. Nurses reported their patient assignment and rated their work environment. More than half of pediatric nurses had missed care on their previous shift. On average, pediatric nurses missed 1.5 necessary care activities. Missed care was more common in poor versus better work environments (1.9 vs 1.2; P < .01). For 9 of 12 nursing activities, the prevalence of missed care was significantly higher in the poor environments (P < .05). In regression models that controlled for nurse, nursing unit, and hospital characteristics, the odds that a nurse missed care were 40% lower in better environments and increased by 70% for each additional patient. Nurses in inpatient pediatric care settings that care for fewer patients each and practice in a professionally supportive work environment miss care less often, increasing quality of patient care. Copyright © 2017 by the American Academy of Pediatrics.

  5. Citation classics in pediatric orthopaedics.

    PubMed

    Varghese, Ranjit A; Dhawale, Arjun A; Zavaglia, Bogard C; Slobogean, Bronwyn L; Mulpuri, Kishore

    2013-09-01

    The purpose of this study was to identify the clinical pediatric orthopaedic articles with at least 100 citations published in all orthopaedic journals and to examine their characteristics. All journals dedicated to orthopaedics and its subspecialties were selected from the Journal Citation Report 2001 under the subject category "orthopedics." Articles cited 100 times or more were identified using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1900 to present). The articles were ranked in a comprehensive list. Two authors independently reviewed the full text of each article and applied the inclusion and exclusion criteria to the list of articles. The 2 lists were then compared. All disagreements were resolved by consensus with input from the senior author. The final list of pediatric orthopaedic articles was then compiled. There were a total of 49 journals under the search category "orthopedics." Five journals were excluded as they were non-English journals. The remaining 44 journals were screened for articles with at least 100 citations. A total of 135 clinical pediatric orthopaedic articles cited at least 100 times were included. The most cited article was cited 692 times. The mean number of citations per article was 159 (95% confidence interval, 145-173). All the articles were published between 1949 and 2001, with 1980 and 1989 producing the most citation classics (34). The majority (90) originated from the United States, followed by the United Kingdom (12) and Canada (11). Scoliosis/kyphosis was the most common topic with 26 papers. The second most common subject was hip disorders (24). Therapeutic studies were the most common study type (71). Ninety-seven papers were assigned a 4 for level of evidence. The list of citation classics in pediatric orthopaedic articles is useful for several reasons. It identifies important contributions to the field of pediatric orthopaedics and their originators; it facilitates the understanding and discourse

  6. The effect of template choice on morphometric analysis of pediatric brain data.

    PubMed

    Yoon, Uicheul; Fonov, Vladimir S; Perusse, Daniel; Evans, Alan C

    2009-04-15

    The present study investigated the "template effect" on the morphometric analysis of a pediatric brain MRI database obtained from 8-year-old children through various measures of surface and volumetric morphologies. We first constructed an age-appropriate template from an independent set of pediatric brain images and then compared it with a well-known adult brain template, the ICBM152, in terms of the morphometric features that resulted from our pediatric database. The individual cortical surface acquired based on the pediatric template exhibited, on average, a significantly thinner cortex (-1.66+/-1.60%, t=-15.18), larger cortical surface areas (0.31+/-0.70%, t=6.52), and a higher degree of cortical folding (0.08+/-0.13%, t=8.72) while compared with those based on the adult template. We also found a significant increase in the cerebrospinal fluid volume (-2.63+/-4.84) for the adult template based brains and the cortical gray matter (GM) volume (6.10+/-7.81) for the pediatric template based brains. The cross-correlation of pediatric template based individual brain data (0.95 without brain mask) was significantly higher than those of adult template based (0.88) and the amount of deformation during non-linear spatial normalization was significantly reduced when using the pediatric template (average magnitude of deformation in the cortical GM class: 1.71 mm vs. 2.23 mm, t=12.39). In addition, an "internal" pediatric template, taken from the study subjects themselves, was generated and compared with the "external" pediatric template for reference. There was no significant difference between these two pediatric brain templates and associated tissue probability maps. The results show that it is necessary to be cautious when interpreting results from pediatric imaging studies based on adult reference data.

  7. Evaluation of Physicians’ Awareness of Pediatric Diseases in Iran

    PubMed Central

    Abolhassani, Hassan; Mirminachi, Babak; Daryabeigi, Maedeh; Agharahimi, Zahra; Aghamohammadi, Asghar; Rabbani, Ali; Rezaei, Nima

    2014-01-01

    Objective: Physicians’ awareness about pediatric health problems is very important in health system. This has not been investigated in Iran as yet. Therefore this study was conducted to characterize the knowledge of the Iranian physicians which has direct association with health status of children. Methods: One hundred and four physicians, mainly pediatric specialists (58.6%) working in the state hospitals (45.1%) were enrolled. They filled a valid and reliable questionnaire, containing 26 questions about basic and important pediatric issues before and after an educational pediatric program (EPP). Findings : Thirty nine (37.5%) physicians answered correctly more than 2/3 of all questions (passed the examination) before EPP, which increased to 42.3% after EEP. Subgroup analysis showed that the total scores of general practitioners (P=0.007) was significantly increased after the EPP. Moreover, physicians with shorter practicing time (P=0.006) and those with shorter time past graduation (P=0.01) had a significant improvement in their total scores after the program. The best scores of educational issues were documented in growth and development (16.0%; P=0.04), followed by dermatology (9.2%, P=0.04), urology (9.1%; P=0.04), and asthma and allergy (9.0%, P=0.04). Conclusion: This study revealed that there are gaps in the knowledge of professionals about the pediatric issues. PMID:25793051

  8. Pediatric pulmonary arterial hypertension: on the eve of growing up.

    PubMed

    Douwes, Johannes M; Berger, Rolf M F

    2017-09-01

    Current recommendations for diagnosis and treatment of pulmonary arterial hypertension (PAH) during childhood are expert opinion based, because of lacking pediatric data. In recent years, however, important pediatric data have emerged on PAH. PAH in children shows similarities as well as differences compared to adults. Neonates and children know specific clinical presentations and a hemodynamic profile that differs from adults with PAH. Children identified as acute vasodilator responders according to the criteria proposed for adults rather than the pediatric criteria have better outcome when treated with calcium channel blockers. For nonresponders, combination PAH-targeted therapy leads to improved outcome compared to monotherapy. In pediatric PAH, WHO functional class, N-terminal pro-brain natriuretic peptide and tricuspid annular plane systolic excursion were identified as surrogates for survival and therefore qualify to be treatment goals in a goal-oriented treatment strategy. In order to refine current pediatric treatment guidelines, data on efficacy of specific treatment regiments and strategies are needed. The recently validated composite endpoint of clinical worsening allows for trials that will provide these data. For the first time, evidence-based treatment goals have been identified that will allow for a goal-oriented treatment strategy. Furthermore, various prognostic predictors have been identified that may prove treatment goals in future.

  9. Pediatric trigger thumb in identical twins: congenital or acquired?

    PubMed

    Kakel, Rafid; Van Heerden, Pieter; Gallagher, Barry; Verniquet, Andrew

    2010-03-01

    Pediatric trigger thumb is an uncommon condition with a calculated incidence of 3 per 1000 live births or less. Some reports have suggested a congenital etiology while others could not find a single case of pediatric trigger thumb at birth. This article reports the occurrence of bilateral trigger thumbs in identical twins, age 3 years and 9 months, affecting their thumbs to similar extents, which may suggest a congenital etiology.Congenital etiology for trigger thumb has been proposed for many reasons: occurrence in infants, occurrence in twins, occasional bilaterality, possible presence of triggering at birth, and absence of history of trauma. The occurrence of pediatric trigger thumb in twins has been reported 3 times in the literature; all reported cases were bilateral, as in our case.The mean age at presentation of pediatric trigger thumb is 2 years. The thumb is usually held in a fixed flexion position (mimicking a fracture). Examination usually reveals a palpable nodule in the flexor pollicis longus tendon at the metacarpal joint. This is an important clinical sign. Triggering in children, however, is rare. Macroscopically, there is a nodular thickening of the tendon itself. Pathological changes can be found in the tendon, tendon sheath, or both. A specimen taken from one of the nodules in our case showed degenerative changes while those from both pulleys were normal.Pediatric trigger thumb responds predictably to A1 pulley release, preferably before age 4 years, although milder cases may resolve spontaneously. Copyright 2010, SLACK Incorporated.

  10. Current Practices for Therapeutic Drug Monitoring of Biopharmaceuticals in Pediatrics.

    PubMed

    Murias, Sara; Magallares, Lorena; Albizuri, Fatima; Pascual-Salcedo, Dora; Dreesen, Erwin; Mulleman, Denis

    2017-08-01

    Biopharmaceuticals have recently emerged as effective treatments for refractory pediatric autoimmune conditions. Several reports have shown a relationship between drug concentration, antidrug antibodies, and clinical response in these patients, strongly suggesting the potential interest, usefulness, and reliability of therapeutic drug monitoring (TDM) in children. This article reviews the current state of research in juvenile idiopathic arthritis, pediatric inflammatory bowel disease, and pediatric psoriasis from a TDM point of view. There is a remarkable lack of evidence-based data in pediatric patients, which is reflected throughout the article. Most investigations of TDM are focused on research of tumor necrosis factor alpha antagonists in inflammatory bowel disease, albeit preliminary publications are emerging from pediatric rheumatologists and dermatologists. To date, immunogenicity has been a primary concern, particularly regarding infliximab and adalimumab therapy in children, as it may lead to a loss of therapeutic response. Preliminary investigations show that adjusting the dose according to blood drug concentrations improves disease outcomes by overcoming antidrug antibodies, suggesting a crucial role for TDM. Patients who receive other drugs, such as etanercept, abatacept, or tocilizumab, could benefit from TDM because dosage can be optimized by adjusting it to the minimum effective dose.

  11. Development of the PROMIS® Pediatric Global Health (PGH-7) Measure

    PubMed Central

    Forrest, Christopher B.; Bevans, Katherine B.; Pratiwadi, Ramya; Moon, JeanHee; Teneralli, Rachel E.; Minton, Jo M.; Tucker, Carole

    2014-01-01

    Purpose To develop a practical, efficient, and valid pediatric global health measure that would be useful for clinical, quality improvement, and research applications. Methods Using the PROMIS mixed-methods approach for item bank development, we identified an item pool that was well understood by children as young as age 8 years, and tested its psychometric properties in an internet panel sample of 3,635 children 8–17 years-old and 1,807 parents of children 5–17 years-old. Results The final version of the pediatric global health measure included 7 items assessing general, physical, mental, and social health. Four of these items had the same wording as the PROMIS adult global health measure. Internal consistency was 0.88 for the child-report form and 0.84 for the parent form; both had excellent test-retest reliability. The measures showed factor invariance across age categories. There was no differential item functioning by age, gender, race, or ethnicity. Because the measure includes the general health rating question, it is possible to estimate the pediatric global health scale using this widely used single item. Conclusions The PROMIS Pediatric Global Health measure is a brief and reliable 7-item summary assessment of a child’s self-reported health. Future work will attempt to statistically link this pediatric form with the PROMIS adult global health measures to create a single global health metric that can be used across the life course. PMID:24264804

  12. Spotlight on topical pimecrolimus in pediatric atopic dermatitis.

    PubMed

    Yang, Lily P H; Curran, Monique P

    2010-01-01

    Topical pimecrolimus 1% cream (Elidel) [hereafter referred to as topical pimecrolimus] is a nonsteroidal alternative in the treatment of pediatric atopic dermatitis. In vehicle-controlled, short-term, continuous-use trials in pediatric patients with mild to moderate atopic dermatitis, topical pimecrolimus was effective in treating disease symptoms. Topical pimecrolimus was effective in preventing disease flares and reducing the need for topical corticosteroids in longer term, intermittent-use trials. In addition, topical pimecrolimus was associated with improvements in the health-related quality of life of pediatric patients with atopic dermatitis and their parents. In vehicle-controlled trials, topical pimecrolimus was generally as well tolerated as vehicle. Topical pimecrolimus showed similar efficacy to topical tacrolimus 0.03% ointment in a short-term, continuous-use trial and the two agents had a generally similar tolerability profile. Although comparative data between topical pimecrolimus and topical corticosteroids are lacking in pediatric patients, and the long-term tolerability (beyond 1-2 years) of topical pimecrolimus is yet to be established, topical pimecrolimus is a useful agent in the management of pediatric patients with mild to moderate atopic dermatitis who do not achieve satisfactory treatment with other topical pharmacologic treatments, including topical corticosteroids.

  13. Nutritional screening in hospitalized pediatric patients: a systematic review.

    PubMed

    Teixeira, Adriana Fonseca; Viana, Kátia Danielle Araújo Lourenço

    2016-01-01

    This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients. A search was performed in the Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), in the SCIELO (Scientific Electronic Library Online), through CAPES portal (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS)/Medical Subject Headings (MeSH) list were "malnutrition", "screening", and "pediatrics", as well as the equivalent words in Portuguese. The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice. The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is essential to carry out studies of tool adaptation and validation for this population. Copyright

  14. Debriefing in pediatrics

    PubMed Central

    2015-01-01

    Debriefing is a conversational session that revolves around the sharing and examining of information after a specific event has taken place. Debriefing may follow a simulated or actual experience and provides a forum for the learners to reflect on the experience and learn from their mistakes. Originating from the military and aviation industry, it is used on a daily basis to reflect and improve the performance in other high-risk industries. Expert debriefers may facilitate the reflection by asking open-ended questions to probe into the framework of the learners and apply lessons learned to future situations. Debriefing has been proven to improve clinical outcomes such as the return of spontaneous circulation after cardiac arrest and the teaching of teamwork and communication in pediatrics. Incorporating debriefing into clinical practice would facilitate the cultural change necessary to talk more openly about team performance and learn from near misses, errors, and successes that will improve not only clinical outcome but also patient safety. PMID:25774195

  15. Endocurietherapy in pediatric oncology.

    PubMed

    Cherlow, J M; Syed, A M; Puthawala, A; Asch, M; Finklestein, J Z

    1990-01-01

    Endocurietherapy (brachytherapy) is the placing of radioactive sources directly into or near a solid tumor. This technique delivers a concentrated dose of radiation to a restricted volume while minimizing radiation effects on normal tissue. We have treated 11 patients (nine sarcomas, one carcinoma, and one Wilms') with endocurietherapy procedures as part of their multimodality treatment program. Six were treated as part of the primary management, and the other five were treated for recurrent or metastatic disease. Temporary afterloaded implants using ribbons embedded with radioactive iridium192 (Ir192) seeds delivered typical tumor doses of 4,000 cGy. Six patients, including four primary cases and two recurrent cases, are currently classified as no evidence of disease (NED) without further local regional treatment (follow-up of 11-62 months; median, 38 months), and one patient treated for metastasis also remains locally controlled. Two patients are classified as alive with disease (AWD), two died of disease (DOD), and one is now NED after surgical salvage. Special considerations were given to gonadal shielding, radioprotection techniques, and psychosocial issues in this pediatric population.

  16. Magnetoencephalography in pediatric epilepsy

    PubMed Central

    Kim, Hunmin; Chung, Chun Kee

    2013-01-01

    Magnetoencephalography (MEG) records the magnetic field generated by electrical activity of cortical neurons. The signal is not distorted or attenuated, and it is contactless recording that can be performed comfortably even for longer than an hour. It has excellent and decent temporal resolution, especially when it is combined with the patient's own brain magnetic resonance imaging (magnetic source imaging). Data of MEG and electroencephalography are not mutually exclusive and it is recorded simultaneously and interpreted together. MEG has been shown to be useful in detecting the irritative zone in both lesional and nonlesional epilepsy surgery. It has provided valuable and additive information regarding the lesion that should be resected in epilepsy surgery. Better outcomes in epilepsy surgery were related to the localization of the irritative zone with MEG. The value of MEG in epilepsy surgery is recruiting more patients to epilepsy surgery and providing critical information for surgical planning. MEG cortical mapping is helpful in younger pediatric patients, especially when the epileptogenic zone is close to the eloquent cortex. MEG is also used in both basic and clinical research of epilepsy other than surgery. MEG is a valuable diagnostic modality for diagnosis and treatment, as well as research in epilepsy. PMID:24244211

  17. [Pediatric neuroimaging emergencies].

    PubMed

    Adamsbaum, C; Rolland, Y; Husson, B

    2004-09-01

    The notion of emergency with regards to pediatric neuroimaging requires a strong knowledge of clinical indications. In children under 2 years of age, head trauma requires a CT scan in case of repeated or prolonged or rapidly increasing vomiting, focal signs, loss of consciousness, unusual behavior, seizures, clinical signs of skull fracture or polytrauma. The "shaken baby syndrome" is usually suspected in case of loss of consciousness or seizures before 8 months of age. The hematomas that are observed are subdural in location, diffuse and deeply located. Imaging is only mandatory for headache suggesting underlying space occupying lesion: permanent or increasing pain, nocturnal headache, headache during postural changes or efforts, associated to seizures or abnormal neurological examination. No imaging is indicated in case of first epileptic seizure associated to normal neurological examination and without any particular context. The presence of trauma, intracranial hypertension, persisting disturbances of consciousness or associated focal sign necessitates urgent neuroimaging. No imaging is indicated in case of typical febrile seizures, i.e. generalized, brief and occurring between 1 and 5 years of age. Spinal cord symptoms require immediate MRI evaluation. The most frequent tumor is neuroblastoma. In the absence of spinal tumor, brain abnormalities must be excluded (inflammatory disease). In neonates, CT scan or MRI must be readily performed in case of seizures or loss of consciousness to exclude ischemic, traumatic or infectious lesions.

  18. Pediatric Trigger Digits.

    PubMed

    Bauer, Andrea S; Bae, Donald S

    2015-11-01

    Pediatric trigger thumb presents not at birth but early in childhood. Most evidence suggests that it is caused by a developmental size mismatch between the flexor pollicis longus tendon and its sheath. Patients generally present with the thumb interphalangeal joint locked in flexion. Surgical reviews report near universally excellent outcomes after open release of the A1 pulley. However, recent reports indicate that there may be a role for nonsurgical treatment for families that are willing to wait several years for possible spontaneous resolution of the deformity. Triggering in digits other than the thumb in children is generally associated with an underlying diagnosis including anatomic abnormalities of the tendons, and metabolic, inflammatory, and infectious etiologies. Although some have advocated nonsurgical treatment, surgery is often necessary to address the underlying anatomic etiology. More extensive surgery beyond simple A1 pulley release is often required, including release of the A3 pulley and resection of a slip of the flexor digitorum superficialis tendon. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Pediatric Eye Screening Instrumentation

    NASA Astrophysics Data System (ADS)

    Chen, Ying-Ling; Lewis, J. W. L.

    2001-11-01

    Computational evaluations are presented for binocular eye screening using the off-axis digital retinascope. The retinascope, such as the iScreen digital screening system, has been employed to perform pediatric binocular screening using a flash lamp and single-shot camera recording. The digital images are transferred electronically to a reading center for analysis. The method has been shown to detect refractive error, amblyopia, anisocoria, and ptosis. This computational work improves the performance of the system and forms the basis for automated data analysis. For this purpose, variouis published eye models are evaluated with simulated retinascope images. Two to ten million rays are traced in each image calculation. The poster will present the simulation results for a range of eye conditions of refractive error of -20 to +20 diopters with 0.5- to-1 diopter resolution, pupil size of 3 to 8 mm diameter (1-mm increment), and staring angle of 2 to 12 degree (2-degree increment). The variation of the results with the system conditions such as the off-axis distance of light source and the shutter size of camera are also evaluated. The quantitative analysis for each eye’s and system’s condition is then performed to obtain parameters for automatic reading. The summary of the system performance is given and performance-enhancement design modifications are presented.

  20. Pediatric Phalanx Fractures.

    PubMed

    Abzug, Joshua M; Dua, Karan; Bauer, Andrea Sesko; Cornwall, Roger; Wyrick, Theresa O

    2016-11-01

    Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits for fractures in the United States. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which makes fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.

  1. Pediatric cranial computed tomography

    SciTech Connect

    Yamada, H.

    1984-01-01

    The introduction of CT in the investigation of intercranial pathology has revolutionized the approach to clinical neurological and neurosurgical practice. This book applies the advances of cranial CT to the pediatric patient. The test is divided into two sections. The first portion describes the practical methodology, anatomy and normal and abnormal CT scan appearance, including high or low density lesions, cystic lesions and ventricular or subarachnoid space dilation. The characteristic scans for various neurological diseases are presented and discussed. The author has given special attention to the CT diagnosis of congenital malformations and cerebral neoplasms. Partial Contents: Normal Computed Tomographic Anatomy/ High Density Lesions/Low Density Lesions/Cystic Lesions; Supratentorial/Cystic Lesions; Infratentorial/Increased Head Circumference/Increased Ventricular Size/Small Ventricular Size/Cranial Lesions/Spinal Lesions/CT Cisternography/Part II CT in Neonates/Congenital Craniocerebral Malformations/Hydrocephalus/Craniosynostosis/Head Trauma/Cerebrovascular Lesions/Intracranial Lesions/Seizure Disorders/Intracranial and Other Chronic Neurological Disorders.

  2. Update on Pediatric Overuse.

    PubMed

    Coon, Eric R; Young, Paul C; Quinonez, Ricardo A; Morgan, Daniel J; Dhruva, Sanket S; Schroeder, Alan R

    2017-02-01

    As concerns over health care-related harms and costs continue to mount, efforts to identify and combat medical overuse are needed. Although much of the recent attention has focused on health care for adults, children are also harmed by overuse. Using a structured PubMed search and manual tables of contents review, we identified important articles on pediatric overuse published in 2015. These articles were evaluated according to the quality of the methods, the magnitude of clinical effect, and the number of patients potentially affected and were categorized into overdiagnosis, overtreatment, and overutilization. Overdiagnosis: Findings included evidence for overdiagnosis of hypoxemia in children with bronchiolitis and skull fractures in children suffering minor head injuries. Overtreatment: Findings included evidence that up to 85% of hospitalized children with radiographic pneumonia may not have a bacterial etiology; many children are receiving prolonged intravenous antibiotic therapy for osteomyelitis although oral therapy is equally effective; antidepressant medication for adolescents and nebulized hypertonic saline for bronchiolitis appear to be ineffective; and thresholds for treatment of hyperbilirubinemia may be too low. Overutilization: Findings suggested that the frequency of head circumference screening could be relaxed; large reductions in abdominal computed tomography testing for appendicitis appear to have been safe and effective; and overreliance on C-reactive protein levels in neonatal early onset sepsis appears to extend hospital length-of-stay.

  3. Pediatric Medullary Thyroid Carcinoma.

    PubMed

    Starenki, Dmytro; Park, Jong-In

    Medullary thyroid carcinoma (MTC), which originates from thyroid parafollicular C cells, accounts for 3 to 5% of thyroid malignancies. MTC occurs either sporadically or in an inherited autosomal dominant manner. Hereditary MTC occurs as a familial MTC or as a part of multiple endocrine neoplasia (MEN) type 2A and B syndromes. A strong genotype-phenotype correlation has been observed between hereditary MTC and germ-line "gain of function" mutations of the RET proto-oncogene. Most cases of pediatric MTC are hereditary whereas sporadic MTC is rare in children and is usually diagnosed in adults. Therefore, MTC in children is most often diagnosed in the course of a familial genetic investigation. The standard treatment of MTC mainly requires surgery involving total thyroidectomy and central neck node dissection before extrathyroidal extension occurs. To prevent MTC development in hereditary syndromes, prophylactic thyroidectomy is performed in presymptomatic patients. An appropriate age at which the surgery should take place is determined based upon the data from genotyping, serum calcitonin measurements, and ultrasonography. For the treatment of advanced MTC cases, the broad spectrum receptor tyrosine kinase inhibitors vandetanib and cabozantinib, which also inhibit RET, are used although they are not always effective.

  4. Pediatric Phalanx Fractures.

    PubMed

    Abzug, Joshua M; Dua, Karan; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O

    2017-02-15

    Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits in the United States for fractures. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which make fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.

  5. Pediatric guidelines for dyslipidemia.

    PubMed

    Daniels, Stephen R

    2015-01-01

    Clinical guidelines are developed to assist clinicians in complex clinical decision making. Modern guideline development includes a systematic review and grading of relevant literature and then using the evidence review to construct recommendations for clinical care which are also graded regarding the level of evidence supporting them. Pediatric guidelines for dyslipidemia were first published in 1992. There was then a gap during which no formal guidelines were developed. In 2011, the National Heart, Lung, and Blood Institute Integrated Guidelines for Cardiovascular Disease Risk Reduction in Children were published. This included an evidence review and clinical recommendations regarding dyslipidemia. This review process began in 2006. The evidence review ended in 2008, and they were published in 2011 because of an extensive and prolonged review process. These guidelines recommend universal screening for dyslipidemia at age 9 to 11 y with a focus on identifying young individuals with genetic dyslipidemia such as familial hypercholesterolemia. The guidelines also include lifestyle recommendations and recommendations for pharmacologic treatment for children with markedly elevated low-density lipoprotein cholesterol. The guideline process should include review of the implementation of guidelines in practice and should also include ongoing review of the guidelines with respect to a growing evidence base with new research findings.

  6. Pediatric brain death determination.

    PubMed

    Mathur, Mudit; Ashwal, Stephen

    2015-04-01

    Clinical guidelines for the determination of brain death in children were first published in 1987. These guidelines were revised in 2011 under the auspices of the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society, and provide the minimum standards that must be satisfied before brain death can be declared in infants and children. After achieving physiologic stability and exclusion of confounders, two examinations including apnea testing separated by an observation period (24 hours for term newborns up to 30 days of age, and 12 hours for infants and children from 31 days up to 18 years) are required to establish brain death. Apnea testing should demonstrate a final arterial PaCO2 20 mm Hg above the baseline and ≥ 60 mm Hg with no respiratory effort during the testing period. Ancillary studies (electroencephalogram and radionuclide cerebral blood flow) are not required to establish brain death and are not a substitute for the neurologic examination. The committee concluded that ancillary studies may be used (1) when components of the examination or apnea testing cannot be completed, (2) if uncertainty about components of the neurologic examination exists, (3) if a medication effect may be present, or (4) to reduce the interexamination observation period. When ancillary studies are used, a second clinical examination and apnea test should still be performed and components that can be completed must remain consistent with brain death.

  7. Primary pediatric mid-brain lymphoma: Report of a rare pediatric tumor in a rare location

    PubMed Central

    Benson, Rony; Mallick, Supriya; Purkait, Suvendu; Suri, Vaishali; Haresh, K P; Gupta, Subhash; Sharma, Dayanand; Julka, Pramod Kumar; Rath, Goura Kishore

    2016-01-01

    Primary central nervous system lymphoma (PCNSL) is a rare disease in pediatric age group. A thirteen-year-old male child presented with complaints of headache for six months, vomiting and diplopia for three days. Magnetic resonance imaging of the brain showed a single lesion of 1.7 cm × 1.6 cm × 1.6 cm in the mid brain and tectum. He underwent a gross total resection of the tumor. The histopathological evaluation revealed B cell high grade non Hodgkin lymphoma. The patient was treated with High dose methotrexate and cranio spinal radiation. The patient was alive without disease 12 mo after completion of treatment. This case highlights importance of keeping PCNSL as differential in brain stem lesions of pediatric patients also. Radiation and chemotherapy remains the most important treatment for such patients. PMID:28035316

  8. American Association for Pediatric Ophthalmology and Strabismus

    MedlinePlus

    American Association for Pediatric Ophthalmology and Strabismus Home About AAPOS Patient Info Resources Allied Health News & Events Meetings J AAPOS American Association for Pediatric Ophthalmology and Strabismus Pay Dues Member ...

  9. Comprehensive training for the future pediatric cardiologist

    PubMed Central

    Subramanyan, Raghavan

    2016-01-01

    India faces a huge burden of pediatric and adult congenital heart diseases (CHDs). Many acquired valvar, myocardial, and vascular diseases also need treatment in childhood and adolescence. The emergence of pediatric cardiology as an independent specialty has been a relatively recent development. A few centers of excellence in pediatric cardiology have developed. However, the requirement of pediatric cardiac care and pediatric cardiologists is far in excess of what is available. There are no guidelines at present in India for uniform training in pediatric cardiology. Many training programs are nonstructured and do not focus on the regional needs. Both core training and advanced training programs are essential to provide adequate numbers of community-level pediatric cardiologists and academic leaders respectively. This article proposes a detailed plan and curriculum for comprehensive training of future pediatric cardiologists in India. PMID:27011684

  10. 15. Detail showing lower chord pinconnected to vertical member, showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Detail showing lower chord pin-connected to vertical member, showing floor beam riveted to extension of vertical member below pin-connection, and showing brackets supporting cantilevered sidewalk. View to southwest. - Selby Avenue Bridge, Spanning Short Line Railways track at Selby Avenue between Hamline & Snelling Avenues, Saint Paul, Ramsey County, MN

  11. Axillary involvement in pediatric Kikuchi's disease.

    PubMed

    Heldenberg, D; Amar, M; Ben-Arie, Y; Iuchtman, M

    1996-02-01

    We report the first Israeli pediatric case of Kikuchi's disease in a 10-year-old male. He was hospitalized for evaluation of migrating arthralgia and fever. Axillary adenopathy was the main physical finding. A biopsy showed a histiocytic necrotizing lymphadenitis. Diagnosis, therapeutic options and the clinical significance of Kikuchi's disease are discussed. Kikuchi's disease should be considered in the differential diagnosis of fever of unknown origin in children, even in the absence of cervical adenopathy. A long follow-up is advised because of possible links with systemic lupus erythematosus and to detect eventual late recurrences.

  12. Imaging of the pediatric thymus: Clinicoradiologic approach

    PubMed Central

    Manchanda, Smita; Bhalla, Ashu S; Jana, Manisha; Gupta, Arun K

    2017-01-01

    The thymus is a lymphatic organ that undergoes dynamic changes with age and disease. It is important to be familiar with these physiological changes in the thymus gland to be able to identify pathology and make an accurate diagnosis. The thymus may be involved in multisystem disorders or show focal isolated lesions. The aim of this article is to review the radiological anatomy of the thymus, normal variants, and pathology including hyperplasia and benign/malignant lesions involving the thymus gland in the pediatric age group. We also propose an algorithmic approach for imaging evaluation of a suspected thymic mass on the basis of morphologic features. PMID:28224091

  13. Advances in Pediatric Intravenous Iron Therapy.

    PubMed

    Mantadakis, Elpis

    2016-01-01

    Iron deficiency anemia (IDA) continues to be very common worldwide. Intravenous (IV) iron is an infrequently used therapeutic option in children with IDA despite numerous studies in adults and several small but notable pediatric studies showing efficacy and safety. Presently, the availability of newer IV iron products allows for replacement of the total iron deficit at a single setting. These products appear safer compared to the high molecular weight iron dextrans of the past. Herein, we review the medical literature and suggest that front line use of IV iron should be strongly considered in diseases associated with IDA in children.

  14. Pediatric scleroderma: systemic or localized forms.

    PubMed

    Torok, Kathryn S

    2012-04-01

    Pediatric scleroderma includes 2 major groups of clinical entities, systemic sclerosis (SSc) and localized scleroderma (LS). Although both share a common pathophysiology, their clinical manifestations differ. LS is typically confined to the skin and underlying subcutis, with up to a quarter of patients showing extracutaneous disease manifestations such as arthritis and uveitis. Vascular, cutaneous, gastrointestinal, pulmonary, and musculoskeletal involvement are most commonly seen in children with SSc. Treatment of both forms targets the active inflammatory stage and halts disease progression; however, progress needs to be made toward the development of more effective antifibrotic therapy to help reverse disease damage. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. A Study to Determine the Best Model and the Optimal Feasible Method for Reducing No-Show Behavior at a Military Social Work Clinic.

    DTIC Science & Technology

    1983-05-01

    pediatric and low socioeconomic populations. From the literature review, it became evident that little data exists for no-show rates in private practices...with psychiatric or mental hygiene clinics; and eight with pediatric outpatient de- partments or clinics. Only two articles were located which dis...Appointments," Pediatrics 34 (July 1964): 128-129. 4Paul J. Carpenter, Garry R. Morrow, Andrew C. DelGuadio, and Barry A. Ritzler, "Who Keeps the First

  16. Recent advances in pediatric uroradiology

    PubMed Central

    Reddy, Pramod P.

    2007-01-01

    Pediatric Urology is a surgical subspecialty that is very dependent upon radiographic imaging as the majority of the genitourinary (GU) tract is internally located. Technological advances in various imaging modalities (e.g. ultrasonography, nuclear medicine, CT and MRI) have aided in our ability to visualize and evaluate the functionality of the GU tract, enabling the diagnosis of various disease processes that affect the genitourinary system. Collectively the advances in uro-radiology have improved our understanding of the natural history of many conditions that involve the GU tract. As a result of these newer imaging modalities, some of the more traditional techniques have assumed a limited role in the diagnostic evaluation of the pediatric GU patient (e.g. intravenous urography). The purpose of this article is to review the advances in radiographic imaging, in particular the cross-sectional imaging modalities and discuss their utility (appropriate indications and application) in Pediatric Urology, so that the reader can maximize the diagnostic yield of these studies. For a thorough review of any of the imaging modalities discussed in this article and their utility in the practice of pediatric urology, I would direct the readers to articles in the radiological literature that are specific to that technology. Besides the obvious technological advances in imaging modalities, this review also discusses the attention to radiation safety for the pediatric patient that every physician who orders a diagnostic imaging study in a child should be aware of. PMID:19718296

  17. Pediatric Interventional Radiology: Vascular Interventions.

    PubMed

    Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

    2016-07-01

    Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery.

  18. Personalized assent for pediatric biobanks.

    PubMed

    Giesbertz, Noor A A; Melham, Karen; Kaye, Jane; van Delden, Johannes J M; Bredenoord, Annelien L

    2016-10-12

    Pediatric biobanking is considered important for generating biomedical knowledge and improving (pediatric) health care. However, the inclusion of children's samples in biobanks involves specific ethical issues. One of the main concerns is how to appropriately engage children in the consent procedure. We suggest that children should be involved through a personalized assent procedure, which means that both the content and the process of assent are adjusted to the individual child. In this paper we provide guidance on how to put personalized assent into pediatric biobanking practice and consider both the content and process of personalized assent. In the discussion we argue that the assent procedure itself is formative. Investing in the procedure should be a requirement for pediatric biobank research. Although personalized assent will require certain efforts, the pediatric (biobank) community must be aware of its importance. The investment and trust earned can result in ongoing engagement, important longitudinal information, and stability in/for the research infrastructure, as well as increased knowledge among its participants about research activity. Implementing personalized assent will both respect the child and support biobank research.

  19. Pediatric neurosurgery: pride and prejudice.

    PubMed

    Winston, K R

    2000-02-01

    Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.

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

    PubMed

    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.