Rationale: Lower respiratory tract infections (LRTI) are a common cause of morbidity and mortality in children. Swallowing problems are also common in children. Aspiration is one outcome of swallowing dysfunction that may be a contributing factor to LRTI. Methods: Retrospective review of children undergoing videofluoroscopic swallow study was done to identify the prevalence and correlates of aspiration and LRTI. Results: Aspiration prevalence was 36.6%. Significant factors on univariate analysis included: developmental delay, LRTI, pneumonia, digestive tract anomalies, indigenous heritage, cough and congestion. With logistic regression, congestion and LRTI correlated with aspiration. Prevalence of LRTI was 42%. Using univariate analysis pneumonia, aspiration and indigenous heritage were significant. With logistic regression, respiratory issues and indigenous heritage correlated with LRTI. Conclusion: The etiology of LRTI is complex and multifactoral. Understanding the relationship between all factors is imperative given that current interventions are invasive and the untreated outcome can be progressive lung injury.

The objective of this study was to determine whether the composite bond strength acquired using a single step self-etching bonding system is as or more effective when compared to the two step etch-rinse-bond system at clinically relevant in-vitro standards. A total of 80 extracted human deciduous with at least one intact smooth surface were collected with parental consent. Collected teeth were randomly assigned to one of four treatment protocols (n=20): single step self-etch (Adper Prompt L-Pop, 3M ESPE), two step etch (15s)-rinse-bond (Optibond Solo Plus, Kerr), single step self etch (Adper L Pop, 3M ESPE) with 30s pre-etch, and two step etch (30s)-rinse-bond (Optibond Solo Plus, Kerr). A composite cylinder of uniform shape was bonded to each tooth using the designated adhesive system and specimens were tested with a universal testing machine. Descriptive statistics and statistical analysis was performed. Median shear bond strengths for all specimens, regardless of treatment group, ranged from 3.25 MPa to 43.13 MPa. These values are above suggested minimum clinical required values of 3MPa. A Kruskal-Wallis analysis between treatment groups found statistical significance (p<0.05) for shear bond strength between the groups and both one step system protocols, had higher mean and median shear bond strength values than the two step systems. An adhesive remnant index (ARI) was analyzed to confirm uniform adhesive fracture between all four treatment groups. Both a Fisher’s exact test, and a Hantel-Haenszel statistic found no significant difference (p<0.05) between the samples. Based on these findings we concluded that: 1. The ARI score for all treatment groups was not statistically significant, suggesting that the type of bond breakage was consistent regardless of adhesive system used. 2. Both Optibond Solo Plus and Adper Prompt L-Pop systems achieve adequate shear bond strengths as described by current literature. 3. The use of a one-step system to save chair time and aid in patient behavior management may be clinically useful.

Background: Every year, in Sweden, 250 children and adolescents below 15 years of age are diagnosed with cancer. Over 75% of those diagnosed are cured. Cancer affects not only the child but the whole family. Siblings of the affected child can easily suffer from a lack of attention. Aim: This study aimed to illuminate siblings' experiences of living in a family with a child affected by cancer. Method: A literature-based study based on nine qualitative studies. Results: The result showed that it was important for siblings to have someone close and not be alone, they needed to feel a community. Not to know and not to understand what has happened made them to feel grief, fear, stress and jealousy. Many siblings felt an insecurity because of a feeling of being forgotten, neglected and a feeling of loneliness due to the changes in everyday life. Conclusion: Parents to a child with cancer have often prioritized the sick child and the needs of the siblings, are left aside. Because the siblings often get sidelined they feel an insecurity when their everyday living get different. If the siblings get a positive experience from this period of illness, this may lead to a positive experience in life which make it easier to process what was happened.

Medulloblastoma is the most common malignant central nervous system (CNS) tumor in childhood. The cranio-spinal radiation (CSR) required to treat this disease results in long-term cognitive and neurologic impairments. Medulloblastoma was recently categorized into four genetic subgroups (WNT, SHH, Group 3, and Group 4). This study examined neuropsychological and intellectual functioning in 91 medulloblastoma patients (41 Group 4; 20 Group 3; 18 SHH; 12 WNT) following treatment, and examined the impact of several medical, treatment and demographic factors on functioning over time. Longitudinal growth curve analyses revealed hydrocephalus most clearly predisposes to poor neuropsychological functioning. Results also indicate medulloblastoma subgroups have heterogeneous intellectual outcomes following treatment. All subgroups experience intellectual declines following treatment; however, comparing between subgroups revealed Group 4 performs most poorly, and Group 3 has the best overall intellectual outcome. Lastly, qualitative analyses suggest treatment with a larger CSR dose may contribute to poor intellectual functioning.

Medulloblastoma is the most common malignant central nervous system (CNS) tumor in childhood. The cranio-spinal radiation (CSR) required to treat this disease results in long-term cognitive and neurologic impairments. Medulloblastoma was recently categorized into four genetic subgroups (WNT, SHH, Group 3, and Group 4). This study examined neuropsychological and intellectual functioning in 91 medulloblastoma patients (41 Group 4; 20 Group 3; 18 SHH; 12 WNT) following treatment, and examined the impact of several medical, treatment and demographic factors on functioning over time. Longitudinal growth curve analyses revealed hydrocephalus most clearly predisposes to poor neuropsychological functioning. Results also indicate medulloblastoma subgroups have heterogeneous intellectual outcomes following treatment. All subgroups experience intellectual declines following treatment; however, comparing between subgroups revealed Group 4 performs most poorly, and Group 3 has the best overall intellectual outcome. Lastly, qualitative analyses suggest treatment with a larger CSR dose may contribute to poor intellectual functioning.

Juvenile idiopathic arthritis (JIA) is a common chronic disease of childhood. Children with JIA have lower peak oxygen consumption (V0₂ peak) than healthy children. In order to examine the cardiorespiratory response during aerobic exercise and the anaerobic to aerobic ratio (metabolic index), maximal exercise tests were performed in JIA subjects and age- and sex-matched controls (CON). Thirteen children aged 10 to 17 years with JIA and 9 CON participated. Peak powe r(watts, W) and total work (Joules, j) were determined with the Wingate anaerobic cycling test. VO₂ peak was measured by a maximal staged exercise test on a cycle ergometer. Cardiac output (CO, liters/minute) was measured with Doppler echocardiography. Arterial — mixed venous oxygen index (A-V0₂) and systemic vascular resistance (SVR) were calculated. Patient questionnaires included habitual activity, visual analog scale for joint pain and the childhood health assessment questionnaire. Physician completed data included active joint count and articular severity index. Compared to CON and reference age-matched norms, JIA subjects had lower aerobic fitness. VO₂ peak in JIA was 31.3 ml/min/kg (20.2-49.9), Z score -1.4 (-.06--2.4) and in CON was 47.9 ml/min/kg (32.7-54.1), Z score of -0.17 (-1.6-.87). [p = 0.013 V0₂ peak, p=0.011 Z score]. There were no significant differences in CO, A-V0₂ or SVR buttrends towards lower CO and higher SVR in JIA subjects were observed. During anaerobic exercise JIA subjects completed less total work (168.5 j/kg (107-252) JIA, 224 j/kg (180-248) CON, p=.036) but had similar peak power (9.7 W/kg (5.6-13.7) JIA, 11.3 W/kg (9.8-14.5) CON, p=.095). The metabolic index did not differ between JIA and CON. There was no significant correlation between disease activity, function and fitness measures in JIA subjects. Children with JIA have moderate impairments in aerobic fitness. CO and A-V0₂ during aerobic exercise did not significantly differ between JIA subjects and CON. Anaerobic fitness was mildly impaired with less total work completed by JIA subjects. Further research with larger numbers is required to determine factors contributing to limited fitness in JIA.

Thesis (MSocSc)--University of South Australia, 1995

Thesis (M.D.) -- University of Adelaide, Dept. of Surgery, 2000. / Includes bibliographical references.

Thesis (Ph.D.)--George Mason University, 2008. / Vita: p. 144. Thesis director: P. J. Maddox. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing. Title from PDF t.p. (viewed July 3, 2008). Includes bibliographical references (p. 129-143). Also issued in print.

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 202-211). Available also in a digital version from Dissertation Abstracts.