Mia Alessandra Nieto is an 8-year old living with Juvenile Idiopathic Arthritis (JIA) in Austin, Texas. When she was diagnosed at 10 months, she was the youngest child ever diagnosed with JIA in the state of Texas. However, it took 37 days to confirm her condition because there is an immense lack on knowledge in the field of pediatric rheumatology among general practitioners despite the fact that JIA is the most prevalent chronic condition in children in the United States with over 300,000 diagnosed. This is an overview of Mia’s story, along with information regarding the lack of knowledge on the condition not only in the general population but mainly and more importantly among the medical professionals in the United States. / text

For children with intractable epilepsy, surgery provides significant reduction in seizure frequency, with no significant declines in intellectual or behavioral functioning (Datta, et al., 2011). Prior to surgery, children must undergo a thorough assessment to determine the location of the seizure-focus and to evaluate risks of post-operative impairment (Lee, 2010). Currently, fMRI offers one of the most reliable and least invasive means of localizing language prior to surgery (McDonald, Saykin, William & Assaf, 2006). Dichotic listening, a behavioral task in which subjects are asked to listen to two competing stimuli simultaneously, offers a possible alternative for children who cannot complete fMRI studies. Previous studies have relied on research-based listening tasks and the type of quantitative analysis of the fMRI rarely available in the clinical setting. Instead, this study examined how well dichotic listening results predict language lateralization from fMRI within a clinical setting. Data were gathered through a records review of 13 children with intractable epilepsy referred to Austin Neuropsychology through the epilepsy treatment team at Dell Children’s Medical Center. Overall, children classified as atypical language dominance on the fMRI studies showed lower levels of right ear advantage on the dichotic listening measure. Despite this trend, a discriminant analysis using the dichotic listening results to predict fMRI classification showed no significant improvement over chance classification. A secondary analysis examined factors related to a child’s ability to complete an fMRI language study, comparing 12 children from the original sample with 6 children referred through the same process and over the same time period who could not obtain a successful fMRI determination of language lateralization. Overall, children who successfully completed the fMRI language studies showed a trend of lower levels of difficulty with behavioral regulation and higher levels of intelligence. Although the non-significant results highlight the limitations of dichotic listening as a clinical tool, the failure rate within the total sample, along with the information about the roles of intelligence and behavioral regulation, may help spur the development of alternative methods of language lateralization. / text

Evidence from the pediatric traumatic brain injury and pediatric brain tumor populations suggests that positive family functioning serves as a protective factor for neurocognitive outcomes of children who survive these conditions. However, no research has been found that examines whether positive family functioning similarly moderates the effects of CNS-directed chemotherapy on the neurocognitive functioning of survivors of pediatric ALL. The purpose of this study is to examine the effect of family functioning upon neurocognitive outcome among survivors of pediatric ALL treated with chemotherapy. Based upon a multidimensional model of attention and Anderson’s model of executive function (EF), four subcomponents of attention (selective, divided, sustained, and shifting) and four subcomponents of EF (working memory, planning, inhibition, and processing speed) will be examined. Sequential, or hierarchical, multiple regression analyses will be conducted to examine the relationship between family functioning and neurocognitive functioning among survivors of pediatric ALL as well as a comparison group of healthy children. Data for the ALL group and the comparison group will be examined using separate analyses, with demographic and treatment-related variables entered first, followed by a family functioning variable. For the ALL group, family functioning is expected to explain a significant amount of variance in neurocognitive outcome, even after controlling for demographic and treatment-related variables. It is expected that this relationship will not be found for the comparison group. If so, this would have important implications for the survivors and their families. For example, survivors from families with lower levels of functioning could be identified early through screening measures and their families could receive targeted interventions aimed at improving family functioning and thus survivor outcomes. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Most of the previous studies about risk factors associated with death in pediatric intensive care unit (PICU) were done in western countries and focused on physiological and laboratorial indexes. Some of them had inconsistent results. There were few studies about the epidemiologic profile of mortality and risk factors associated with death in the PICU in China. Compared with other countries, China has different health care policy, insurance system, population, culture, and socioeconomic situation that may affect disease outcomes differently. Some data showed that Chinese PICUs had higher mortality. It is important to know more about the possible factors associated with excess death in PICU in a Chinese setting. Objectives: The objectives of this study were to estimate mortality (incidence proportion of death) in pediatric intensive care unit (PICU) in a tertiary hospital and identify the main risk factors associated with death in PICU. Methods: This was a case-control study. We retrospectively investigated the clinical data of patients who were admitted to the PICU during January 2010 to December 2013 in a tertiary hospital in Guangzhou, China. All the dead cases in PICU during the studied period were chosen as cases, and the controls were randomly selected from the patients who were alive when they were discharged from the PICU during the same period. The incidence proportion of death was estimated, and then logistic regression model was carried out to explore the risk factors for death. Results: The overall mortality in this PICU was 6.5% (95% CI 5.6 % - 7.4%) during January 2010 to December 2013. The following factors were found to have significant association with higher risk for death: middle level socioeconomic status (OR 2.51, 95% 1.07 - 5.87) and low level socioeconomic status (OR 5.86, 95% CI 2.32 - 14.77) compared with the high level socioeconomic status; admission from pediatric emergency observation unit (OR 2.08, 95% CI 1.10 - 3.91) compared with admission from transfer system (i.e. other hospital); critical severity of disease (OR 2.62 , 95% CI 1.48 - 4.64), and seriously critical severity of disease (OR 8.41, 95% CI 3.26 - 21.67) compared with non-critical severity of disease ; existence of multiple organ dysfunction syndrome (OR 3.64, 95% CI 1.91- 6.91) compared with absence of multiple organ dysfunction syndrome; existence of comorbidity (OR 3.14, 95% CI 1.68 - 5.86) compared with absence of comorbidity; infectious disease (OR 2.42, 95% CI 1.07- 5.49), neoplasm (OR 4.53, 95% CI 1.63 - 12.62), neurological disease ( OR 4.21, 95% CI 1.85 - 9.59) and endocrine, immune and nutritional disease (OR 7.56, 95% CI 2.10 - 27.20 ) compared with respiratory disease . Conclusion: Our study was the first one to comprehensively investigate the risk factors for death in PICU of a tertiary hospital in China. We described profile of dead cases, estimated the mortality and investigated the risk factors associated with death in PICU. During January 2010 to December 2013 the mortality in the PICU was found to be 6.5%, and risk factors for higher mortality in PICU included lower level socioeconomic status, admission from the pediatric emergency observation unit, more severe conditions of disease, presence of comorbidity and multiple organ dysfunction syndrome, and disease categories of infectious diseases, neoplasm, neurological disease, and endocrine, immune and nutritional disease. Our study provided information for developing preventive strategy to reduce the mortality in PICU. / published_or_final_version / Public Health / Master / Master of Public Health

Unfortunately, one rite of passage of childhood is often serious injury that carries psychological impact along with the obvious physical repercussions. Prior studies have found conflicting results for protective/risk factors, thus this study attempted to explore PTSD in a sample of children ages seven to thirteen years of age with moderate to severe injuries. In this study (N = 32), 31.3% of children experiencing such a sudden injury requiring hospitalization at the University of Kentucky Childrens Hospital demonstrated significant indications of post-traumatic stress disorder (PTSD) following the injury. Several pre, peri, and post-trauma variables from during the childs hospitalization to the follow-up period four to five weeks later were correlated with this outcome including age, ethnicity, acute stress disorder (ASD) with or without dissociation criteria being met, prior medical experience, parents score on the BSI-18 while the child is still in this hospital, chronic illness status, gender, number of coping strategies reported by the child while in the hospital, the number of negative coping strategies reported, the amount of pain reported, and several follow-up variables (parents BSI-18 score, number of coping strategies reported, number of negative and positive coping strategies reported, injury threat, and total number of impairments reported by the child and by the parent). Negative coping did not significantly change from the in-hospital period to the follow-up period. Surprisingly, the STEPP, a current screener described and supported by some past research, was not successful in identifying these at-risk children; however, a new screening prototype was developed including age, acute stress disorder (ASD), and pain that did successfully predict 80% of those with PTSD and 85% of those without later PTSD. A follow-up screener consisting solely of parental items (parental symptoms on the BSI-18 and parental rating of child impairments) was also created and found to sensitively predict 90% of those children with PTSD. Implications from these findings along with study strengths and weaknesses were highlighted.

The American Academy of Pediatrics (AAP) released a statement recommending that primary care providers perform developmental screening with a standardized instrument for all 9-, 18-, 24-, or 30-month well-child visits. Despite evidence-based recommendations by the AAP, numerous pediatric practices do not currently use a standardized instrument for well-child visits. This quality improvement project aimed to determine the feasibility of implementing the Ages and Stages Questionnaire (ASQ), a validated developmental screening tool, at a pediatric primary care practice. In order to accurately assess implementation barriers and benefits, this feasibility study would have determined if the ASQ was the right fit for this pediatric practice. The first phase of implementation would have begun with the 9-month well-child visits and using the same process, later expanded to include the 18- and 24-month visits. The Plan-Do-Study-Act (PDSA) method would have provided the implementation framework for this project and the project would have been written utilizing the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. However, due to unforeseen complications, this project was unable to be completed as planned. Instead, this project discusses outcomes of the DNP project without data, and provides guidance and points of consideration for future implementation in pediatric primary care settings.

No description available.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

The purpose of this study was to determine the relationship between anxious/depressed and withdrawn symptoms and performance on a variety of cognitive and academic achievement measures. The sample included 343 subjects, drawn from a pool of subjects aged 6 to 11 years who were part of a sleep apnea study. A comprehensive battery of selected tests that measured cognitive and academic achievement function was administered to all sampled subjects. Parents of the subjects were given an instrument to complete in order to assess behavior function.The obtained data were analyzed by using Pearson Product Moment Correlation Coefficient analyses, T test procedures, and chi-square analyses. A significant negative correlation was found between anxious/depressed and withdrawn symptoms and the following cognitive and academic measures: general intelligence including verbal and nonverbal abilities, language, specific executive function skills, attention and processing speed, psychomotor speed and coordination with the dominant hand trial, and a subtest assessing math problem solving skills.There were statistically significant differences found between those subjects who obtained approaching borderline and clinically significant anxious/depressed, withdrawn, and both anxious/depressed and withdrawn symptoms on the following cognitive and academic measures: general intelligence including verbal and nonverbal abilities, language, specific executive function skills, attention and processing speed, psychomotor speed and coordination with the dominant hand, the interference and/or delayed recall trial of a memory task, and basic reading, math problem solving, and early spelling/writing skills.There was a significant difference found with regard to parent education level for children identified with withdrawn symptoms as compared to children without these symptoms but there were no other differences with regard to age, gender, ethnicity, or parent education level for children identified with anxious/depressed or withdrawn symptoms as compared to children without these symptoms. Additionally, Caucasian children performed significantly better than Hispanic children on a variety of the cognitive and academic measures.Overall, these findings support the hypotheses that depressive symptomatology does impact performance on cognitive and academic measures. Additionally, methodological problems for exercising caution in the interpretation of obtained findings were discussed. The implications of these findings for psychological practitioners, educators, and physicians were described.