Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 138-145).

Thesis (M.S.)--University of Michigan, 1988.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 49-54).

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Wisconsin-Madison, 1992. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 81-90).

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

<p>Uvod: Značajno mesto u morbiditetu nedono&scaron;čadi predstavljaju plućne bolesti. Ultrazvučnim (UZ) pregledom pluća može se smanjiti ukupna doza jonizujućeg zračenja kojoj su nedono&scaron;čad izložena u svakodnevnom kliničkom radu. Cilj: Ispitati povezanost između UZ nalaza na plućima i RTG nalaza i kliničkih parametara respiratornog statusa kod nedono&scaron;čadi. Utvrditi da li se UZ-om detektovane subpleuralne konsolidacije mogu morfolo&scaron;ki diferencirati. Utvrditi da li UZ nalaz na plućima pomaže neonatologu u proceni efekta terapije tokom lečenja nedono&scaron;čadi. Materijal i metode: Prospektivnim tipom jednogodi&scaron;njeg istraživanja obuhvaćeno je 100 nedono&scaron;čadi kojoj je nakon prijema na Odeljenje intenzivne nege i terapije (OINT) bio indikovan RTG snimak pluća. Za izvođenje UZ pregleda pluća kori&scaron;ćeni su Siemens Sonoline Adara i Siemens Sonoline Sienna UZ aparati. Kori&scaron;ćena je siva skala i konveksna sonda (5 MHz) i linearna sonda (7,5 MHz). Za ispitivanje korelacije između UZ nalaza na plućima i kliničkih parametara respiratornog statusa (FiO2, PCO2, SaO2) kori&scaron;ćen je Pearson-ov koeficijent korelacije. Posebno je ispitivana korelacija kod nedono&scaron;čadi koja su bila na mehaničkoj ventilaciji (MV) i kod nedono&scaron;čadi koja su bila na oksigenoterapiji (OxTh). Utvrđivanje razlika između UZ-om uočenih konsolidacija i RTG-om uočenih konsolidacija, urađeno je prebrojavanjem ukupnog broja uočenih konsolidacija svakom od dve navedene radiolo&scaron;ke metode i poređenjem prosečnog broja uočenih konsolidacija UZ-om, odnosno RTG-om. U svim statističkim testovima je kori&scaron;ćen je nivo značajnosti p&lt;0,05 i interval poverenja (CI) 95%. Rezultati: Kod nedono&scaron;čadi koja su bila na MV, kao i kod nedono&scaron;čadi na OxTh, postoji statistički značajna korelacija između UZ nalaza na plućima i kliničkih parametara respitatornog statusa (p&lt;0,001). Kod bolesnika na MV procenat podudaranja, odnosno nepodudaranja UZ nalaza i FiO2 iznosio je 81%, odnosno 19%. Procenat podudaranja, odnosno nepodudaranja UZ nalaza i PCO2 je bio 80%, odnosno 20%, dok je u slučaju SaO2 procenat podudaranja sa UZ nalazom bio 80%, a nepodudaranja 20%. Kod nedono&scaron;čadi na MV, procenat podudarnosti UZ nalaza na plućima i sva tri klinička parametra zabeležen je u 68%, sa dva klinička parametra u 21%, dok je u 11% zabeležena podudarnost samo sa jednim kliničkim parametrom. Kod nedono&scaron;čadi koja su bila na OxTh procenat podudaranja, odnosno nepodudaranja UZ nalaza i FiO2 iznosio je 94%, odnosno 6%. Procenat podudaranja, odnosno nepodudaranja UZ nalaza i PCO2 je bio 94%, odnosno 6%, dok je u slučaju SaO2 procenat podudaranja sa UZ nalazom bio 93%, a nepodudaranja 7%. Kod nedono&scaron;čadi na OxTh procenat podudarnosti UZ nalaza na plućima i sva tri klinička parametra zabeležen je u 85%, sa dva klinička parametra u 10%, dok je u 5% zabeležena podudarnost samo sa jednim kliničkim parametrom. Prosečan broj UZ-om uočenih konsolidacija po svakom pojedinačnom UZ pregledu pluća je bio 0,80, dok ih je na pojedinačnom RTG snimku uočeno 0,25. U 29% slučajeva konsolidacije su istovremeno uočene i UZ i RTG pregledom pluća, dok je u 71% slučajeva konsolidacije bilo moguće otkriti samo UZ pregledom pluća. Od ukupno 304 subpleuralnih konsolidacija koje su uočene UZ-om, u 172 slučaja (56,58%) je na osnovu prethodno klinički i/ili laboratorijski postavljene dijagnoze indirektno utvrđeno poreklo konsolidacije: u 125 slučajeva (72,67%) uzrok je bio atelektaza, u 39 slučajeva (22,67%) neonatalna pneumonija i u 8 slučajeva (4,66%) plućna hemoragija. Zaključci: Postoji statistički značajna korelacija između ultrazvučnog nalaza na plućima nedono&scaron;čadi i kliničkih parametara respiratornog statusa - FiO2, PaCO2 i SaO2, kako kod nedono&scaron;čadi na MV, tako i kod nedono&scaron;čadi na OxTh, zbog čega ultrazvučni nalaz na plućima može biti od pomoći neonatologu u praćenju efekta primenjene terapije. Na osnovu karakteristika ultrazvučno uočenih subpleuralnih konsolidacija nije moguće utvrditi njihovu etiologiju, već samo u korelaciji sa kliničkim i laboratorijskim nalazima. Ultrazvuk pluća je senzitivnija metoda za uočavanje subpleuralnih konsolidacija u odnosu na radiografiju pluća.</p> / <p>Introduction: Lung diseases play a major role in morbidity of premature neonates. Using lung ultrasound (LUS) as a diagnostic tool lowers the dose of ionizing radiation of prematures in every day clinical work. Objectives: To assay the interconnection between LUS and chest X ray (CXR) and clinical parameters of respiratory status (FiO2, PCO2 i SaO2) in prematures. To investigate the possibility of sonographic determination of etiology of subpleural consolidations based on their appearance. To determine whether LUS can be of clinical benefit to the neonatologist in assessing the effect of therapy used in treating prematures. Material and methods: Prospective one year study included 100 premature neonates who underwent a CXR exam after the admission in the Intensive care unit (ICU). Siemens Sonoline Adara i Siemens Sonoline Sienna US machines were used, as well as the gray scale, convex probe (5 MHz) and linear probe (7,5 MHz). Pearson correlation coefficient was used to test the interconnection between LUS and clinical parameters of respiratory status (FiO2, PCO2, SaO2). The test was performed separately for both prematures on mechanical ventilation (MV) and prematures on oxygen therapy (OxTh). Determination of differencies between consolidations seen on LUS and those seen on CXR was done by counting the number of consolidation detected with each method and by comparing the average number of consolidations detected with LUS and by CXR. The assessment of statistical significance was done using the p value, and the p value&lt;0,05 and the confidence interval (CI) of 95% was considered as statistically significant. Results: Statistically significant correlation (p&lt;0,001) was established between clinical parameters of respiratory status and LUS both in prematures on MV and on OxTh. The percentage of concurrence, or nonconcurrence of LUS and FiO2 was 81% and 19% (respectively). The percentage of concurrence, or nonconcurrence of LUS and PCO2 was 80% and 20% (respectively), while in case of SaO2 the percentage of concurrence with LUS was also 80% and the percentage of nonconcurrence was 20%. In the group of prematures on MV the percentage of concurrence of LUS with all three clinical parameters was in 68%, with two parameters the concurrence was evident in 21% and with a single clinical parameter in 11%. In prematures on OxTh, the percentage of concurrence, or nonconcurrence of LUS and FiO2 was 94% and 6% (respectively). The percentage of concurrence, or nonconcurrence of LUS and PCO2 was also 96% and 4% (respectively), while in case of SaO2 the percentage of concurrence with LUS was also 93% and the percentage of nonconcurrence was 7%. In the group of prematures on OxTh the percentage of concurrence of LUS with all three clinical parameters was in 85%, with two parameters the concurrence was evident in 10% and with a single clinical parameter in 5%. The mean number of subpleural consolidations detected by LUS per exam was 0.80. The mean number of consolidations detected on each CXR was 0.25. In 29%&nbsp; consolidations were detected both with LUS and CXR, but in 71% consolidations were only detected using LUS. 304 subpleural consolidations were seen on LUS, but only in 172 cases (56.58%) it was possible to determine the etiology of consolidations and this was done indirectly, in concordance with previously clinically and/or laboratory diagnosis: in 125 cases (72.67%) the origin was atelectasis, in 39 cases (22.67%) neonatal pneumonia and in 8% (4.66%) pulmonary haemorrhage. Conclusion: Statistically significant interconnection between LUS and clinical parameters of respiratory status &ndash; FiO2, PaCO2 i SaO2 exists both in MV prematures and prematures with oxygen supplementation. Previously mentioned suggests that LUS can be of use to neonatologist in following the effect of administred therapy in prematures. The origin of subpleural consolidations cannot be determined on the basis of their appereance or features seen on LUS. The etiology of sonographic subpleural consolidations can only be indirectly determined in correlation with clinical and laboratory findings. LUS is more sensitive than CXR in detecting subpleural consolidations.</p>

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Masters of Science Degree in Occupational Therapy, by course work. Johannesburg, 1992. / The incidence of learning problems in a group of Normal and At-Risk preterm children was deterlined in this study. The children were allocated to Normal and At- Risk groups using the Neurodevelopmental Assessment Scale (NDS). The NOS was designed by Muriel Goodman for her thesis, "Evaluation of Physiotherapy on Preterm Infants", submitted to the Faculty of Medicine, University of he Witwatersrand, Johannesburg, in fulfilment of the requirements for the Degree of Doctor of Philosophy, 1987. [Abbreviated Abstract. Open document to view full version]

Introdução: O potencial evocado auditivo de estado estável (PEAEE) é uma técnica promissora no diagnóstico precoce da surdez, tratando-se de um método objetivo, que estima o grau de sensibilidade em diferentes freqüências e oferece recursos diferenciais como: o emprego da avaliação dicótica e simultânea para diferentes freqüências, tornando o teste mais rápido, além da detecção automática da resposta garantindo a confiabilidade dos resultados. Objetivo: obter limiares para o PEAEE, em lactentes nascidos a termo e pré-termo, com audição normal, a fim de investigar o processo de maturação das respostas e verificar possíveis ajustes no protocolo, para aplicação clínica no diagnóstico precoce da surdez. Método: estudo coorte e prospectivo para análise dos limiares obtidos no PEAEE para 60 orelhas (30 para cada grupo) utilizando o programa Master®, com análise automática da resposta, pela aplicação do F-teste, com p-valor < 0,01, pesquisa de limiar em 5-5 dB, com estimulação monótica e simultânea para 500, 1000, 2000 e 4000 Hz. Resultados e discussão: Os limiares encontrados, em dB NPS foram mais elevados para o grupo Pré-termo sendo, em média, 49,11 (± 9,44), 26,38 (± 6,59), 26,74 (± 7,57) e 35,9 (± 8,23) e para o grupo Termo foram em média 44,30 (± 9,88), 27,8 (± 6,79), 26,77 (± 6,09) e 32,87 (± 6,12), para as freqüências de 500, 1000, 2000 e 4000 Hz, respectivamente. O protocolo sugerido foi viável e o tempo de coleta foi em média 1h e 20 min. O tempo de coleta pode ser reduzido para 40 minutos, visando a aplicação clínica, se utilizadas as condições de p-valor < 0,05 e pesquisa de limiar em 10-10 dB, já que a diferença entre os limiares foi de apenas 2 dB, quando comparados aos resultados obtidos pelo protocolo sugerido. Os critérios p-valor < 0,01 e pesquisa de limiar de 5-5 dB podem ser estratégias para confirmação da resposta, pois apesar da detecção automática ser um diferencial desta metodologia esta não eximiu a interpretação do examinador para análise final dos resultados. Conclusão: Os limiares para o PEAEE, em lactentes com audição normal demonstram o amadurecimento das respostas entre 35-39 semanas de idade. Os resultados encontrados foram mais elevados do que o esperado, para respostas eletrofisiológicas, especialmente para as freqüências de 500 e 4000 Hz e, portanto, sua aplicação deve ser criteriosa para identificação de lactentes com audição normal. / Introduction: Auditory steady-state evoked response (ASSR) is a promising technique to early diagnosis of hearing loss, as an objective method to estimate hearing sensibility in different frequencies. This technique offers some particular features: the use of dichotic and simultaneous frequency stimulation, allowing a short-duration assessment in addition to the automatic response detection providing a reliable outcome. Objective: to obtain ASSR thresholds, for preterm and term young-infants, with normal hearing, to investigate the maturational process of response and to verify how the protocol could be adjusted, for clinical application for early detection of hearing loss. Method: a cohort and prospective analysis of ASSR thresholds obtained to 60 ears (30 per group) by Master® program using monotic and simultaneous frequency stimulation for 500, 1000, 2000 and 4000 Hz, with automatic response detection, by the F-test, at p-value <0.01 and 5 dB-step threshold seek. Results and Discussion: the thresholds for Preterm group were higher than Term and the mean values, in dB SPL, were 49.11 (± 9.44), 26.38 (± 6.59), 26.74 (± 7.57) and 35.9 (± 8. 3) for Preterm group and 44.30 (± 9.88), 27.8 (± 6.79), 26.77 (± 6.09) and 32.87 (± 6.12), for Term group at 500, 1000, 2000 and 4000 Hz, respectively. The adopted protocol was feasible and the average time collection was 1h 20 min. The time collection can be reduced to 40 min, for clinical application, considering the response detection at p-value < 0.05 and 10 dB-step threshold seek, as the difference on thresholds were only 2 dB, when compared to the suggested protocol. The p-value < 0.01 and 5-dB step threshold seek can be a strategy to confirm the presence of response, besides the automatic detection, which does not exclude the examiner interpretation for final outcomes. Conclusion: The ASSR thresholds in young-infants, with normal hearing, demonstrate a maturational effect from 35 to 39 weeks of age. The ASSR results were elevated, considering an electrophysiological response, especially for 500 and 4000 Hz, and therefore it has to be applied carefully to identify normal hearing neonates.