This thesis: "The current status of pediatrics nurse field and its impacts on practice" deals with actual problem and it means education of pediatrics nurses. There were set two targets: 1. Changes in pediatrics nurses field in time. 2. Detections of problems in education of pediatrics nurses that are caused by new changes in the study program. These targets were specified by four research points and three hypothesis yet. Implementation of research was carried by a combination of qualitative and quantitative research methods. Five head nurses participated to the research and then one hundred nurses from children's unit in hospital as well. Our research was divided in three parts. In the first there were made interviews with head nurses. We used semi - structured form. In second phase we spread our written survey in pediatrics nurses who are working in children's unit. It was created an online survey mainly for students of medical disciplines for comparison. In last phase there were analyzed documents of work load of nurses from children's unit. Results show that in practice there we are able to see many problems. Pediatrics nurses who completed their education in high school grow old. New ones are missed and it means that like pediatrics nurses work general nurses as well. In our survey we found out that nurses with different length of practice are the same opinion on education. Then that pediatrics and general nurses, who are working in children's unit perceive the problems equally. But nurses with different length of practice are different opinion on actual long of study. Final results of this thesis will be published in professional journal.

BACKGROUND: Patients suffering from inflammatory bowel disease (IBD) are at increased risk of vitamin D deficiency. Daily or weekly vitamin D supplementation has not proven to be effective in improving vitamin D status, and it is thought that this failure has been primarily due to a lack of compliance. Circulating vitamin D is crucial to bone growth and development in children and adolescents. However, more recent data has demonstrated that vitamin D also plays a significant role in the maintenance and regulation of the immune system. OBJECTIVES: The primary aim of this study is to investigate the safety and efficacy of administering high dose oral vitamin D therapy in pediatric patients with IBD. We chose to study patients receiving Remicade, an immunosuppressive monoclonal antibody therapy administered intravenously, as the need for scheduled hospital-based infusions provides a unique opportunity to ensure compliance in our study population. METHODS: We identified consecutive pediatric patients with IBD with a recent 25-hydroxyvitamin D (25OHD) level < 30ng/mL, maintained on Remicade, and with no history of kidney or liver disease for inclusion in the study from November 2017 and November 2018. Enrolled patients received one-year of open-label therapy. Vitamin D treatment doses were assigned by Remicade interval and patients received either 50,000 international units (IU) (every 4-5 weeks) or 100,000 IU (every 6-8 weeks) vitamin D3 orally at the time of their Remicade infusions. In addition to vitamin D levels, spot urine calcium to creatinine ratios, serum calcium, phosphorus, and blood urea nitrogen (BUN) levels, quality of life metrics, and surveys pertaining to dietary vitamin D intake and ultraviolet B (UVB) radiation exposure were collected throughout the study period. RESULTS: Baseline vitamin D status in enrolled patients did not differ by gender, dosing group, diet, or diagnosis (Crohn disease or ulcerative colitis). Subjects reached steady-state serum 25OHD levels after three doses administered over a span of 4 to 8 months, our data demonstrated an increase in average 25OH vitamin D levels from 21.17 ng/mL to 28.19 ng/mL in the 50,000 IU and 23.00 ng/mL to 33.18 ng/mL in the 100,000 IU dose groups, respectively. The improvement in vitamin D status did not correlate with changes in quality of life or disease activity. The response to vitamin D therapy was independent of diet, sun exposure, race, gender, diagnosis, or season of enrollment. There were no adverse events, including changes in urine calcium to creatinine excretion or serum BUN and creatinine values. Several patients manifest a small decrease in serum phosphorus during the initial phase of the study. However, these changes were transient and no subjects exhibited clinical signs or symptoms of hypophosphatemia. CONCLUSION: High dose, interval vitamin D supplementation achieved steady-state 25OHD levels of 30 ng/mL or greater, with no signs of toxicity in patients enrolled in this pilot study. These data suggest that high-dose interval therapy may be a feasible treatment option that bypasses limitations related to difficulties with patient compliance. Further studies are necessary to determine optimal dosage regimens and to assess endpoints related to immune function and improvements to gastrointestinal health.

Este estudo teve como objetivos realizar a adaptação cultural do Family Management Measure (FaMM) para a língua portuguesa do Brasil; avaliar a confiabilidade da versão adaptada do Family Management Measure (FaMM) verificando a consistência interna de seus itens em amostra de família de crianças e adolescentes com doença crônica. Na realidade brasileira, não se localizou qualquer outro instrumento que tivesse objetivos iguais, nem semelhantes aos propostos pelo FaMM, além de haver uma lacuna no que diz respeito à maneira como a família maneja a situação de doença crônica da criança. Consiste de um estudo metodológico com abordagem quantitativa a fim de alcançar os objetivos propostos, seguindo as seguintes etapas: tradução, adaptação transcultural do Family Management Measure para o português e validação das propriedades de medida do instrumento adaptado. Para tanto, utilizou-se a metodologia proposta por Guillemin para tradução e adaptação transcultural de instrumentos (Guillemin 1993, 2002), composta pelo seguinte processo: permissão dos autores para a adaptação transcultural e validação do Family Management Measure (FaMM); tradução para língua portuguesa do Family Management Measure; obtenção do primeiro consenso das versões traduzidas; avaliação pelo Comitê de Especialistas; retrotradução - (Back translation); pré-teste; tratamentos dos dados. A população da pesquisa foi composta por 72 famílias de crianças e adolescentes com doenças crônicas em atendimento em um ambulatório de especialidades de hospital-escola público no município de Londrina. A confiabilidade interna medida através do Alfa de Cronbach foi de 0,8660 para o instrumento todo e variou de 0,4430 a 0,7908 entre as dimensões do instrumento. Houve a eliminação do item 35 da dimensão Esforço de manejo. Concluiu-se que o Family Management Measure (FaMM) apresenta-se adaptado para a língua portuguesa do Brasil e recomenda-se a realização de outros estudos junto a outros familiares de crianças. / This study aimed to realize the cultural adaptation of the Family Management Measure (FaMM) for the Portuguese language of Brazil, to evaluate the reliability of the adapted version of the Family Management Measure (FaMM) by verifying the internal consistency of the items from a family sample of children and adolescents with a chronic disease. In Brazil, no other instrument having the same goals was located, nor were any similar to those proposed by FaMM, moreover there is a gap regarding how the family handles the child\'s chronic illness. This was a methodological study with a quantitative approach attempting to achieve the proposed objectives, following these steps: translation and cultural adaptation of the Family Management Measure to Portuguese; validation of the measurement properties of the adapted instrument. For this purpose, the methodology proposed by Guillemin was used for the translation and the cultural adaptation of instruments (Guillemin 1993, 2002) consisting of the following process: Permission of the authors for the cultural adaptation and validation of the Family Management Measure (FaMM) Translation into Portuguese the Family Management Measure; Obtaining the consent of the first translated versions; Evaluation Committee of Experts; Retro-translation - (Back translation); Pre-test; Treatment of the data. The study population consisted of 72 families with children and adolescents who have chronic diseases being attended in specialty outpatient clinic in a public teaching hospital in Londrina. The internal reliability measured with Cronbach\'s alpha was 0.8660 for the entire instrument and varied from 0.4430 to 0.7908 between the dimensions of the instrument. There was an elimination of item 35 in the dimension \"Stress management. It can be concluded that the Family Management Measure (FaMM) appears to adapt well to the Portuguese language in Brazil and it is recommended that further studies be performed with other families with children.

BACKGROUND: Early-term infants (37-38 weeks) are at increased risk of short- and long-term morbidities compared with full term infants (39-40 weeks). In 2009, the American College of Obstetricians and Gynecologists (ACOG) issued guidelines to discourage early elective deliveries prior to 39 weeks of gestation, and Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA, adopted a policy to implement these guidelines. The impact of this policy on Neonatal Intensive Care Unit (NICU) utilization at BIDMC is unknown. Objectives: The objectives of this study were to (1) examine the gestational age distribution of infants at BIDMC from 2004 to 2015 and confirm a reduction in proportion of early-term births (37-38 weeks) after policy implementation in 2009, (2) compare the incidence of NICU admissions among infants ≥37 weeks of gestation before and after policy implementation, and (3) compare the length of NICU stays among infants ≥37 weeks of gestation before and after policy implementation. METHODS: We conducted a medical record review of infants ≥37 weeks of gestation born from January 1, 2004, through November 10, 2015. We used chi-square tests to compare the incidence of early-term deliveries and NICU admissions in two time periods: 2004-2008 (pre-period) and 2010-2015 (post-period). We excluded infants born in 2009 from the analysis. We used logistic regression to calculate the odds ratio of both short (>4 to <24 hours) and long (≥24 hours) NICU admissions in the two time periods. NICU stays ≤4 hours were excluded as they most often occur among asymptomatic infants for evaluation of sepsis in the setting of maternal fever during labor. We also excluded infants transferred to other hospitals. We considered potential confounding variables such as multiple births, maternal age, race and ethnicity, parity, insurance, and marital status. We compared median lengths of stay using a Wilcoxon test. RESULTS: A total of 50,373 infants were born ≥37 weeks of gestation during the study period, 46,254 of whom were included in the analysis excluding 4,119 infants born in 2009, the washout period. The incidence of early-term delivery was lower in the post-period (27.1%) versus the pre-period (34.2%) (P <0.0001). We detected a slight but statistically insignificant decrease in the incidence of overall NICU admissions from 9.1% in the pre-period to 8.9% in the post-period (P = 0.3). The incidence of short NICU admissions also decreased from 5.3% in the pre-period to 4.6% in the post-period (P < 0.0001). Interestingly, there was an increase in the incidence of long NICU stays from 3.8% in the pre-period to 4.3% in the post-period (P = 0.006). Term infants born after 2009 had lower odds of short NICU stays in adjusted models (adj. OR 0.84; 95% CI 0.77, 0.91). Among NICU admissions >4 hours, the median length of stay (LOS) increased from 21 hours (pre-period) to 39 hours (post-period) (P <0.0001). CONCLUSION: A local policy aligned with ACOG national guidelines to reduce early elective deliveries was associated with a reduction in early-term births. We observed a concurrent reduction of short but not long NICU stays. Our findings suggest that a reduction in early elective deliveries before 39 weeks of gestation may lead to more opportunities for infants to stay with their families in the first 24 hours but may not affect the incidence of significant morbidities requiring longer NICU stays. / 2017-06-16T00:00:00Z

Shaken Baby Syndrome is a form of child abuse estimated to occur to one in 20,000 babies and presumed to occur when a carer cannot cope with a constantly crying child and so gives it a sharp shake. This causes the brain to move within the skull, stretching and possibly tearing the veins that bridge the fluid filled gap. To better understand this condition, experiments were performed to measure the mechanical properties of bridging veins followed by detailed mathematical modelling of the motion of a baby’s brain in response to shaking. Few finite element models of shaken baby syndrome exist, and those either ignore the fluid surrounding the brain or model it as a soft solid. The importance of modelling the fluid properly is demonstrated, and the reliability of MSC.Dytran’s fluid-solid interaction modelling is confirmed. The first three-dimensional finite element model of shaken baby syndrome which accurately includes the cerebrospinal fluid is created and used to estimate tolerance criteria for causing subdural haematoma by shaking. This research concludes that shaking of a baby could produce bridging vein strain close to the tolerance for failure and hence should be considered a possible cause of subdural haematoma.

Arthrogryposis, Renal dysfunction, and Cholestasis (ARC) syndrome is a multisystem disorder associated with abnormal localisation of some polarised membrane transporter proteins. Distinct apical and basolateral poles are essential for epithelial function and organ development but the molecular pathways determining the biogenesis of polarised membranes are not fully characterised. Mutations in VPS33B, a Sec1-Munc18 protein, account for 75% of ARC patients. Reduced expression of VPS33B at both the RNA and protein level was demonstrated in all ARC syndrome patients, even if mutations were not identified in VPS33B. A novel protein POLARIN (PLRN) was identified that interacts with VPS33B, and is crucial for VPS33B function. Pathogenic mutations in PLRN occur in ARC patients without VPS33B mutations. Decreased Polarin and Vps33b expression in mouse renal collecting duct cells led to abnormal localisation of specific apical membrane proteins and to disordered apical junction complex formation. In an in vivo model, knockdown of polarin in zebrafish resulted in defects in biliary tract development. These findings establish that a VPS33B-POLARINRab11a intracellular trafficking pathway is functionally distinct from another VPS33-related pathway (VPS33A/VPS16) and is required for (a) normal epithelial polarisation and apical junction complex formation, and (b) normal liver and kidney development and function.

The work presented in the present thesis investigated the neural, behavioural and genetic markers that may be associated with the manifestation of behavioural problems during the early years of life. Across four different empirical studies, and by incorporating, behavioural, neurophysiological and genetic investigations, it was demonstrated that: (1) there are neurophysiological signatures that may be associated with the manifestation of behavioural problems early in life; (2) common genetic variations that determine serotonin variability are strongly associated with affectivity-related patterns of frontal brain activation; and that (3) normal genetic variations that modulate serotonin availability and neuroplasticity are each associated with affectivity-related patterns of visual scanning behaviours in response to faces and aversive scenes. Taken together, the results illustrate the existence of robust neural, genetic and behavioural markers that may be associated with the manifestation of behavioural problems in early childhood and prompt further investigation of the area by generating novel hypotheses. Together, the empirical findings of the thesis provide a first stage contribution to the complex mechanisms that may yield risk and resilience for behavioural problems during the early years of life by generating a more comprehensive insight on the field of affectivity.

INTRODUCTION Brain tumours are the most common solid tumour in childhood, while Magnetic Resonance Spectroscopy (MRS) studies have been performed on brain tumours previously, the majority have been performed on the adult patient population and at long echo times. The work presented in this thesis outlines work performed in the usage of short echo time MRS in the characterisation of childhood brain tumours. METHODS Short echo time MRS was performed on children with brain tumours at the time of diagnostic imaging. In addition, follow up data was accrued for some patients. Resulting spectra were assessed for characteristics either of diagnosis, prognosis or treatment response. RESULTS Spectra collected were used in assessing characteristics of an array of childhood brain tumours. Initially the technique was tested on a well understood dataset of cerebellar tumours, and was later expanded to provide diagnostic aids for both brain stem tumours and pineal region tumours. A group of pilocytic astrocytomas were assessed for differences by location within the brain, for prognosis and for response to treatment. CONCLUSIONS The additional information given by short echo time MRS was useful in the characterisation of childhood brain tumours

Adolescents are especially vulnerable to mental health difficulties (Collip et al, 2008; Bhardwa, 2013; Costello et al, 2003). The Child and Adolescent Mental Health Service (CAMHS) Review (DCSF & DoH, 2008) highlighted barriers to support including capacity difficulties, stigma, young people’s lacking knowledge and a lack of tailored services. Research, demonstrates weaknesses within young people’s knowledge and beliefs regarding mental health and mental health support and historically accumulated stigmatising attitudes. A paucity of research also exists on young people’s wishes for support (Dogra, 2005; Worall-Davies & Marino-Francis, 2008). The aim of this study is to use a mental health literacy framework (Jorm, 2000) to explore the knowledge, beliefs, attitudes and wishes of a community sample of young people regarding mental health and mental health support. This is to inform prevention and intervention within Hightown Local Authority and Highfields school(1). Adopting critical realism, focus groups and thematic analysis (Guest et al, 2012; Boyatzis, 1998) were used. Main findings illustrate the young people’s broad knowledge-base, largely appropriate beliefs and attitudes. Opportunities were revealed for educationally-based, preventative support which enhances detail and security of knowledge, and addresses attitudes in gender sensitive ways. At the intervention-level, preferences were indicated for tiered support, with professional support delivered externally to school. In terms of delivery of support, feeling well-supported was important, along with confidentiality, accessibility, empathy and tailored support to their needs. In carrying forward these findings, the role of the EP, alongside the school and other stakeholders, is exemplified as integral.

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering; and, (B.S.)--Massachusetts Institute of Technology, Dept. of Ocean Engineering, 1976. / Microfiche copy available in Archives and Engineering. / Includes bibliographical references (leaf 41). / Carl A. Wales. / B.S.