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Benefit of BP Measurement in Pediatric ED Patients  [PDF]
Karen M. Poor,Tamara Bostrack Ducklow
ISRN Nursing , 2012, DOI: 10.5402/2012/627354
Abstract: Introduction. Obtaining blood pressures in pediatric emergency department patients is the standard of care; however, there is little evidence to support its utility. This prospective study assesses the benefit of BP acquisition in patients ≤5 years. Methods. Data were collected by the ED triage nurses on 649 patients in two community hospital EDs. Relationships between abnormal blood pressures and the patients’ age, acuity, and calm versus not-calm emotional state were analyzed. Results. There were significant differences in the rate of elevated BPs in the calm and not-calm groups of patients. Overall, one- and two-year-old patients were more likely to have elevated BPs than those in other age groups. Very few patients in the sample had hypotension (1%). There was no relationship between Emergency Severity Index (ESI) acuity level and an abnormal BP. Nineteen percent of calm patients had elevated BPs, with 3.6% of patients in the stage two class of hypertension. Conclusions. There is limited benefit in obtaining BPs in children age of five or less regardless of whether the child is calm or not in ESI acuity levels 3 and 4. 1. Introduction The standard of care in emergency departments is to obtain a blood pressure (BP) during the triage of an injured or ill pediatric patients. Obtaining a BP in pediatric patients, particularly in children under the age of 5 years, is often difficult. Moro-Sutherland [1] notes that “an accurate BP measurement can be difficult to obtain in a young, active, or crying child; can be time-consuming; and requires the use of a properly sized cuff.” This process can be a discomforting or even traumatizing experience. Studies have shown that BP acquisition in the pediatric emergency population is inconsistent and variable [2–4]. BPs are obtained in the ED to assess for either hypotension or hypertension. Hypotension in children is considered to be a late sign of decreased tissue perfusion. Tachycardia, cool and pale distal extremities, prolonged capillary refill, weak pulses, depressed mental status, tachypnea, and decreased urinary output are present prior to a decrease in the systolic BP [5]. The incidence of hypertension in the pediatric population is thought to be approximately 3.6% [6], although, with the epidemic of obesity in children, that number may be higher [7]. Numerous studies have shown a correlation between hypertension in adolescence and cardiovascular disease later in life; however, that correlation does not seem to be strong until the patient is more than five years of age [8]. The Fourth Report on the Diagnosis,
Pediatric CT of the Lung: Influences on Image Quality  [PDF]
Enno Stranzinger, Sebastian Tobias Schindera, Jennifer Larissa Cullmann, Ralph Herrmann, Shu-Fang Hsu Schmitz, Rainer Wolf
Open Journal of Radiology (OJRad) , 2013, DOI: 10.4236/ojrad.2013.31007
Abstract:

Objective: To assess influential factors of CT on image quality of the lung in children. Materials and methods: Retrospective evaluation of 82 consecutive chest-CT-scans in 50 children (1-16 years, 17 females and 33 males). Two pediatric radiologists evaluated in consensus the subjective image quality on lung windows using a 4-point scale (1 = very good, 2 = good, 3 = moderate, 4 = poor). Ventilation, motion artifacts and beam hardening artifact were included in this score. The effects of the following factors were evaluated: 1) CT-settings (tube energy, tube current); 2) Patient’s age, weight, chest size, ventilation; 3) Artifacts of devices, tubes and lines; 4) Combination MRI of the abdomen prior to CT of the chest with the same sedation/anesthesia in oncological patients. Results: The odds of having a better image quality increase with patient’s age, weight and chest diameter in a multiple-factor model. There was no difference between tube current protocols. In infants (<

Pediatric imaging: Current and emerging techniques  [cached]
Shenoy-Bhangle A,Nimkin K,Gee M
Journal of Postgraduate Medicine , 2010,
Abstract: Imaging has always been an important component of the clinical evaluation of pediatric patients. Rapid technological advances in imaging are making noninvasive evaluation of a wide range of pediatric diseases possible. Ultrasound and magnetic resonance imaging (MRI) are two imaging modalities that do not involve ionizing radiation and are preferred imaging modalities in the pediatric population. Computed tomography (CT) remains the imaging modality with the highest increase in utilization in children due to its widespread availability and rapid image acquisition. Emerging imaging applications to be discussed include MR urography, voiding urosonography with use of ultrasound contrast agents, CT dose reduction techniques, MR enterography for inflammatory bowel disease, and MR cine airway imaging.
Infant Cardiac CT Angiography with 64-Slice and 256-Slice CT: Comparison of Radiation Dose and Image Quality Using a Pediatric Phantom  [PDF]
Yi-Wei Lee, Ching-Ching Yang, Greta S. P. Mok, Tung-Hsin Wu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0049609
Abstract: Background The aims of this study were to investigate the image quality and radiation exposure of pediatric protocols for cardiac CT angiography (CTA) in infants under one year of age. Methodology/Principal Findings Cardiac CTA examinations were performed using an anthropomorphic phantom representing a 1-year-old child scanned with non-electrocardiogram-gated (NG), retrospectively electrocardiogram-gated helical (RGH) and prospectively electrocardiogram-gated axial (PGA) techniques in 64-slice and 256-slice CT scanners. The thermoluminescent dosimeters (TLD) were used for direct organ dose measurement, while dose-length product and effective mAs were also used to estimate the patient dose. For image quality, noise and signal-to-noise-ratio (SNR) were assessed based on regions-of-interest drawn on the reconstructed CT images, and were compared with the proposed cardiac image quantum index (CIQI). Estimated dose results were in accordant to the measured doses. The NG scan showed the best image quality in terms of noise and SNR. The PGA scan had better image quality than the RGH scan with 83.70% dose reduction. Noise and SNR were also corresponded to the proposed CIQI. Conclusions/Significance The PGA scan protocol was a good choice in balancing radiation exposure and image quality for infant cardiac CTA. We also suggested that the effective mAs and the CIQI were suitable in assessing the tradeoffs between radiation dose and image quality for cardiac CTA in infants. These results are useful for future implementation of dose reduction strategies in pediatric cardiac CTA protocols.
Resectable Pediatric Nonrhabdomyosarcoma Soft Tissue Sarcoma: Which Patients Benefit from Adjuvant Radiation Therapy and How Much?  [PDF]
Lynn Million,Sarah S. Donaldson
ISRN Oncology , 2012, DOI: 10.5402/2012/341408
Abstract: It remains unclear which children and adolescents with resected nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) benefit from radiation therapy, as well as the optimal dose, volume, and timing of radiotherapy when used with primary surgical resection. This paper reviews the sparse literature from clinical trials and retrospective studies of resected pediatric NRSTS to discern local recurrence rates in relationship to the use of radiation therapy. 1. Introduction NRSTS in the pediatric age group is a challenging group of tumors to manage due to a variety of reasons, particularly for the radiation oncologist. The diversity of histologic subtypes may influence the sensitivity of tumors to radiation. The spectrum of anatomical sites may preclude a complete marginal resection in certain sites, which in turn influences the dose of radiation needed to control disease. The patterns of local tumor spread also influence the optimal treatment volume. Additionally, the uncommon occurrence of pediatric NRSTS, which is only approximately 500 cases per year, and the wide age distribution from infancy to adulthood add to the challenges of determining appropriate radiation dose, volume, and timing relative to surgical resection [1]. Many radiation oncologists reference guidelines established for adult soft tissue sarcomas for radiation therapy dose and volume based on sarcoma grade, tumor size, and resectability. However, patients in the pediatric age group are unique from adults for many reasons including growth and fertility considerations and longer life span to develop late effects of radiation including an enhanced risk for second malignant tumor induction. Radiation therapy dose and volume guidelines for rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in childhood, have been established through a series of phase III prospective trials conducted over 4 decades by the Intergroup Rhabdomyosarcoma Study Group (IRSG) and COG [2–5]. Similar trials have not been conducted for the pediatric NRSTS. As no standard of care currently exists for managing this diverse group of tumors, the current challenge for children with soft tissue sarcoma, other than rhabdomyosarcoma, is to identify which patients benefit from the addition of radiation therapy and to determine the lowest optimal radiation dose and volume to be administered, so as to avoid injury to normal tissues and minimize risk for the development of a second cancer. 2. Who Benefits from Adjuvant Radiation Therapy for Resectable Pediatric NRSTS? Patients with resectable soft tissue sarcoma are known to have a
Choice of Mel Filter Bank in Computing MFCC of a Resampled Speech  [PDF]
Laxmi Narayana M.,Sunil Kumar Kopparapu
Computer Science , 2014,
Abstract: Mel Frequency Cepstral Coefficients (MFCCs) are the most popularly used speech features in most speech and speaker recognition applications. In this paper, we study the effect of resampling a speech signal on these speech features. We first derive a relationship between the MFCC param- eters of the resampled speech and the MFCC parameters of the original speech. We propose six methods of calculating the MFCC parameters of downsampled speech by transforming the Mel filter bank used to com- pute MFCC of the original speech. We then experimentally compute the MFCC parameters of the down sampled speech using the proposed meth- ods and compute the Pearson coefficient between the MFCC parameters of the downsampled speech and that of the original speech to identify the most effective choice of Mel-filter band that enables the computed MFCC of the resampled speech to be as close as possible to the original speech sample MFCC.
Identification of children who may benefit from self-hypnosis at a pediatric pulmonary center
Ran D Anbar, Susan C Geisler
BMC Pediatrics , 2005, DOI: 10.1186/1471-2431-5-6
Abstract: A retrospective chart review was conducted for all newly referred patients to the SUNY Upstate Medical University Pediatric Pulmonary Center during an 18 month period beginning January 1, 2000. Patients were offered hypnosis if they presented with symptoms or signs suggestive of psychological difficulties. Hypnosis was taught in one or two 15–45 minute sessions by a pediatric pulmonologist.Of 725 new referrals, 424 were 0–5 years old, 193 were 6–11 years old, and 108 were 12–18 years old. Diagnoses of anxiety, habit cough, or vocal cord dysfunction accounted for 1% of the 0–5 year olds, 20% of the 6–11 year olds, and 31% of the 12–18 year olds. Hypnotherapy was offered to 1% of 0–5 year olds, 36% of 6–11 year olds, and 55% of 12–18 year olds. Of 81 patients who received instruction in self-hypnosis for anxiety, cough, chest pain, dyspnea, or inspiratory difficulties, 75% returned for follow-up, and among the returning patients 95% reported improvement or resolution of their symptoms.A large number of patients referred to a Pediatric Pulmonary Center appeared to benefit from instruction in self-hypnosis, which can be taught easily as a psychological intervention.Emotional difficulties can trigger respiratory symptoms such as dyspnea [1]. Further, psychological issues can arise as a result of patients' reactions to pulmonary disease, e.g., depression with end-stage cystic fibrosis [2]. In some patients, a vicious cycle ensues as pulmonary disease leads to psychological difficulties, which in turn trigger further symptoms that can be misinterpreted as arising from the pulmonary disease [3]. Thus, a patient with severe asthma can develop anxiety as a result of the life-threatening nature of the disease. Such stress can cause dyspnea, which might be treated inappropriately with therapy for asthma rather than anxiety [4]. In a study by Ortega et al. [5], 49% of children with asthma from cohorts in New Haven, Atlanta, NewYork, and Puerto Rico were identified through the Di
Progesterone Treatment Shows Benefit in a Pediatric Model of Moderate to Severe Bilateral Brain Injury  [PDF]
Rastafa I. Geddes, Eric A. Sribnick, Iqbal Sayeed, Donald G. Stein
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087252
Abstract: 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.
Resampled random processes in gravitational-wave data analysis  [PDF]
Andrzej Krolak,Massimo Tinto
Physics , 2000, DOI: 10.1103/PhysRevD.63.107101
Abstract: The detection of continuous gravitational-wave signals requires to account for the motion of the detector with respect to the solar system barycenter in the data analysis. In order to search efficiently for such signals by means of the fast Fourier transform the data needs to be transformed from the topocentric time to the barycentric time by means of resampling. The resampled data form a non-stationary random process. In this communication we prove that this non-stationary random process is mathematically well defined, and show that generalizations of the fundamental results for stationary processes, like Wiener-Khintchine theorem and Cram\`{e}r representation, exist.
RIO: Analyzing proteomes by automated phylogenomics using resampled inference of orthologs
Christian M Zmasek, Sean R Eddy
BMC Bioinformatics , 2002, DOI: 10.1186/1471-2105-3-14
Abstract: Here we present RIO (Resampled Inference of Orthologs), a procedure for automated phylogenomics using explicit phylogenetic inference. RIO analyses are performed over bootstrap resampled phylogenetic trees to estimate the reliability of orthology assignments. We also introduce supplementary concepts that are helpful for functional inference. RIO has been implemented as Perl pipeline connecting several C and Java programs. It is available at http://www.genetics.wustl.edu/eddy/forester/ webcite. A web server is at http://www.rio.wustl.edu/ webcite. RIO was tested on the Arabidopsis thaliana and Caenorhabditis elegans proteomes.The RIO procedure is particularly useful for the automated detection of first representatives of novel protein subfamilies. We also describe how some orthologies can be misleading for functional inference.Accurate computational protein function analysis is an important way of extracting value from primary sequence data. Due to the large amount of data, automated systems seem unavoidable (at least for initial, prioritizing steps). Such efforts are complicated, for a variety of reasons. Many proteins belong to large families, as suggested by Dayhoff [1]. Such families are often composed of subfamilies related to each other by gene duplication events. For example, Ingram [2] showed that human α, β, and γ chains of hemoglobins are related to each other by gene duplications. Gene duplication allows one copy to assume a new biological role through mutation, while the other copy preserves the original functionality [3,4]. Hence, subfamilies often differ in their biological functionality yet still exhibit a high degree of sequence similarity.Other complications in functional analysis include: ignoring the multi-domain organization of proteins; error propagation caused by transfer of information from previously erroneously annotated sequences; insufficient masking of low complexity regions; and alternative splicing [5].Typically, automated sequence funct
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