Upper extremity biomechanical model for evaluation of pediatric joint demands during wheelchair mobility

Current methods for evaluating upper extremity (UE) dynamics during pediatric wheelchair use are limited. We propose a new model to characterize UE joint kinematics and kinetics during pediatric wheelchair mobility. The bilateral model is comprised of the thorax, clavicle, scapula, upper arm, forearm, and hand segments. The modeled joints include: sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist. The model is complete and is currently undergoing pilot studies for clinical application. Results may provide considerable quantitative insight into pediatric UE joint dynamics to improve wheelchair prescription, training and long term care of children with orthopaedic disabilities.

Quality of life and life skill baseline measures of urban adolescents with disabilities

Many gaps exist in the understanding of how adolescents with disabilities successfully transition to adulthood and the services contributing to this success. This study attempts to fill one gap by establishing quality of life baseline measures for low-income urban adolescents. We compared baseline data for a representative sample of adolescents with disabilities in the District of Columbia to national norms using three instruments-the Pediatric Quality of Life Inventory 4.0, the Ansell-Casey Life Skills Assessment, and the Career Maturity Inventory-Attitude Scale. The sample for this study was primarily African American and had a higher level of disability as measured by receipt of Supplemental Security Income (SSI). The baseline scores of the adolescents in DC may be lower than the normed scores of their peers with disabilities in the U.S. because of socioeconomic and racial inequities and because the population has to contend with greater levels of disabilities.

The role of rigid and flexible bronchoscopy in children

Bronchoscopy for paediatric respiratory disease is a routine procedure in paediatric pulmonology. Rigid bronchoscopy is now much less commonly used than flexible bronchoscopy. Technological advances have brought better picture quality and easier storage of video documentation. Indications with clear clinical benefit are congenital or acquired unexplained airway obstruction. In pulmonary infections or infiltrates in immunodeficient or immunosuppressed children not responding to empirical treatment a pathogen may be identified by bronchoscopy and bronchoalveolar lavage (BAL). Bronchoscopy and BAL can be indicated in children with unusual presentations of chronic cough or wheeze, and cystic fibrosis. The use of transbronchial biopsies (TBB) is established in paediatric lung transplantation. New applications and techniques are being developed, such as endobronchial ultrasound and transbronchial needle biopsy of lymph nodes and the role of airway stent placement have become better understood.

Accuracy of the Broselow tape in estimating the weight of First Nations children

INTRODUCTION

During resuscitation, the Broselow tape (BT) is the standard method of estimating pediatric weight based on body length. The First Nations population has a higher prevalence of obesity and experiences more injury than the non-First Nations population. The prevalence of obesity has raised the concern that the BT may not accurately estimate weight in this population. The purpose of this study was to validate the BT in 8 First Nations communities.

METHODS

We performed a search of the electronic medical records of 2 community health centres that serve 8 local First Nations communities. We searched for the most recent clinic visit during which height and weight had been recorded in the records of patients less than 10 years of age with a postal code indicating residence in a First Nations community. The patients' actual weight was compared with their BT weight estimates using the Bland-Altman method. The Spearman coefficient of rank and percentage error was also calculated.

RESULTS

A total of 243 children were included in the study (119 girls, 124 boys). The mean age was 33.3 months (95% confidence interval [CI] 29.7 to 36.9), mean height was 91.8 cm (95% CI 89.0 to 94.6), mean weight was 16.2 kg (95% CI 15.0 to 17.3)and mean BT weight was 14.0 kg (95% CI 13.1 to 14.8). The Bland-Altman percent difference was 11.9% (95% CI -17.3% to 41.1%). The Spearman coefficient of rank correlation was 0.963 (p < 0.001). The BT had a percentage error greater than 10% error 51.8% of the time, with 49.4% being underestimations.

CONCLUSION

The BT was often not accurate at estimating the weight of children in 8 First Nations communities; it underestimated their weight almost half of the time.

Utilizing Ecological Momentary Assessment in pediatric obesity to quantify behavior, emotion, and sleep

This study examined the feasibility of using Ecological Momentary Assessment (EMA) to examine important domains relevant to interregulatory health processes in overweight adolescent females in their natural environments. Participants were 20 overweight adolescent females engaged in a cognitive-behavioral and motivational interviewing intervention aimed at weight loss and improving mood (11-19 years old, 80% white, 15% African American, mean BMI = 39). During this EMA protocol, participants were asked to report their physical activity (PA), nutrition, mood, and sleep during 14 cellular phone calls over three extended weekends (Thursday to Monday). Simultaneously, participants wore an actigraph (armband and watch communicator) that provided instantaneous PA feedback (steps taken and kilocalories) and sleep parameters (duration and efficiency). EMA compliance rates for the armband and phone calls were 74.7 +/- 0.3% and 64.2 +/- 0.3%, respectively. Data from the armband and phone calls are presented to illustrate the depth of information acquired by utilizing this innovative methodology.

Avian endosurgery

Endoscopy has proven to be an important diagnostic tool for avian veterinarians wishing to visualize and biopsy internal structures. To date, most of the described endoscopic procedures are single-entry techniques. The use of miniature laparoscopy equipment has been pioneered in human pediatrics and many of these instruments now can be used used in zoologic companion animal practice. The addition of a second and third port using 2.5 or 3.5 mm cannulae has facilitated the use of 2 or 3 mm instruments within the avian coelom. Triangulation of various instruments, coupled with radiosurgical hemostasis, has made several procedures including salpingohysterectomy and orchidectomy possible endoscopically. In addition, endoscope-assisted minimally invasive procedures including enterotomy, enterectomy, cloacopexy, and pneumotomy may be initiated internally and completed using more established techniques externally. The advent of minimally invasive endoscopic surgery offers significant benefits including rapid and accurate diagnosis, reduced need for an extensive coeliotomy, reduced surgical stress, more stable anesthesia, and reduced hospitalization periods.

Medical devices; pediatric uses of devices; requirement for submission of information on pediatric subpopulations that suffer from a disease or condition that a device is intended to treat, diagnose, or cure; direct final rule. Direct final rule

The Food and Drug Administration (FDA) is amending the regulations on premarket approval of medical devices to include requirements relating to the submission of information on pediatric subpopulations that suffer from the disease or condition that a device is intended to treat, diagnose, or cure. Elsewhere in this issue of the Federal Register, we are publishing a companion proposed rule under FDA's usual procedure for notice and comment to provide a procedural framework to finalize the rule in the event we receive significant adverse comment and withdraw this direct final rule.

Flow visualization of three-dimensionality inside the 12 cc Penn State pulsatile pediatric ventricular assist device

In order to aid the ongoing concern of limited organ availability for pediatric heart transplants, Penn State has continued development of a pulsatile Pediatric Ventricular Assist Device (PVAD). Initial studies of the PVAD observed an increase in thrombus formation due to differences in flow field physics when compared to adult sized devices, which included a higher degree of three-dimensionality. This unique flow field brings into question the use of 2D planar particle image velocimetry (PIV) as a flow visualization technique, however the small size and high curvature of the PVAD make other tools such as stereoscopic PIV impractical. In order to test the reliability of the 2D results, we perform a pseudo-3D PIV study using planes both parallel and normal to the diaphragm employing a mock circulatory loop containing a viscoelastic fluid that mimics 40% hematocrit blood. We find that while the third component of velocity is extremely helpful to a physical understanding of the flow, particularly of the diastolic jet and the development of a desired rotational pattern, the flow data taken parallel to the diaphragm is sufficient to describe the wall shear rates, a critical aspect to the study of thrombosis and design of such pumps.

Clinical evaluation of the Terumo Capiox FX05 hollow fiber oxygenator with integrated arterial line filter

Perfusion techniques and equipment in pediatric open heart surgery have continued to focus on decreasing prime volumes and lowering surface areas of the cardiopulmonary bypass circuit. While this has improved drastically over the last 20 years, greater demand is being placed on the perfusionist to reduce the deleterious effects of bypass without compromising safety or efficiency. Specifically, manufacturers of disposable perfusion equipment have focused on providing pediatric perfusionists with oxygenators that provide the smallest prime and surface area possible while attempting to maximize performance. Recently,Terumo Cardiovascular has introduced the Capiox FX05, a neonatal hollow fiber oxygenator that includes an integrated arterial line filter. The FX05 provides a blood flow range of 0.1-1.5 L/min and a low priming volume of 43 mL. Additionally, it is coated with X Coating, a biocompatible, hydrophilic polymer surface coating that reduces platelet adhesion and protein denaturation. The purpose of this study was to test the FX05 for gas transfer, blood path resistance, and blood handling characteristics in a standardized clinical setting. Heat exchange coefficients were also calculated during the cooling and warming period. Other data analyzed includes bypass circuit prime volumes and initial patient hematocrit along with the total operative homologous blood donor exposures. In summary, the FX05 offers good gas exchange capabilities and a low pressure drop during normal cardiopulmonary bypass parameters along with the safety of an integrated arterial line filter. Furthermore, the FX05 with integrated filter allows a reduction in overall bypass prime volume and surface area while promoting the reduction of homologous blood transfusions, optimizing hemostasis.

Clinical gaseous microemboli assessment of an oxygenator with integral arterial filter in the pediatric population

The use of an arterial line filter (ALF) within the pediatric cardiopulmonary bypass (CPB) circuit is not a new concept. It has always presented the perfusionist with a circuit component that while valuable, increased prime volume. The purpose of this study was to evaluate the change in prime volume and emboli between a conventional oxygenator with separate ALF and a new generation oxygenator with integral arterial filter (AF). We performed a clinical, non-randomized retrospective evaluation of the Terumo Capiox RX15 (Terumo Cardiovascular Systems Corporation, Ann Arbor, MI) (n = 10) in conjunction with the Terumo Capiox AF125X ALF or the Capiox AF02 vs. the Terumo Capiox FX15 oxygenator with integral AF (n = 10). The above circuit components, in combination with the LUNA EDAC (emboli detection and classification) Quantifier (LUNA Innovations, Blacksburg, VA) were placed at various locations within each patient's CPB circuit to establish and quantify the presence and volume of gaseous emboli during all phases of cardiopulmonary bypass. The EDAC system is available/used for all patients undergoing CPB at this institution. When compared to a more conventional CPB circuit, the Capiox FX15 primes more easily as it does not require a carbon dioxide flush while still providing a 32 microm AF. There was no statistical difference in air handling between the tested oxygenators and their associated circuits. During this review it was determined that use of the Capiox FX15 simplifies the arterial limb of the pediatric CPB circuit. Removal of the separate ALF led to the removal of several, now unnecessary, arterial connectors and additional tubing (arterial line filter bypass). Removal of these components led to a reduction in prime volume and decreased the hemodilutional effect. The FX15 provided a safe, simplified pediatric CPB circuit and was as effective in gaseous microemboli removal as was the more traditional RX15 with separate ALF during this review.

Animal model development for the Penn State pediatric ventricular assist device

In March 2004, the National Heart, Lung, and Blood Institute awarded five contracts to develop devices providing circulatory support for infants and small children with congenital and acquired cardiac disease. Since 2004, the team at Penn State College of Medicine has developed a pneumatically actuated ventricular assist device (VAD) with mechanical tilting disk valves. To date, hemodynamic performance, thrombogenesis, and hemolysis have been chronically evaluated in 16 animals, including 4 pygmy goats and 12 sheep. Major complications, mainly respiratory failure, have been encountered and resolved by a multi-disciplinary team. Multi-modal analgesia, appropriate antibiotic therapy, and attentive animal care have contributed to successful outcomes. Time after implant has ranged from 0 to 40 days. Most recently, a sheep implanted with Version 3 Infant VAD was electively terminated at 35 days postimplant, with no major adverse events. This report describes a successful in vivo model for evaluating a pediatric VAD.

[Information-wave technologies: rationale and guidelines for their use in pediatrics]

The mechanisms of action of information-wave technologies on human beings are analyzed in detail and their use in pediatrics is substantiated. The approach using a now-frequency pulse electromagnetic field as an information factor is optimal due to the synchronization of an oscillatory process of a low-frequency pulse electromagnetic field and the rhythm of functioning of different systems of the body, which causes the bioresonance actions the function of an organ or a system.

The use of the Statscan digital X-ray unit in paediatric polytrauma

We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided.

Health-related quality of life in two itinerant samples: carnival and migrant farm worker children

The document Healthy People 2010 sets a national health care agenda that includes reducing health disparities and improving quality of life. This study evaluated health-related quality of life (HRQOL) in children aged 2 to 12 years being raised in two itinerant populations: traveling carnival children (n=33) and migrant farm worker children (n=48), and compared their outcomes to each other and to findings in published literature. The study sample utilized cluster sampling from outdoor amusement companies (carnivals) and agricultural farms who agreed for the researcher to enter their premises and speak with their workers. The PedsQL Generic Core Scales, including a child self-report and parent-proxy, measured HRQOL. HRQOL of the itinerant children did not differ from that of a more geographically stable California sample. The carnival children's mean scores were higher than the migrant farm worker children's scores on 7 out of 12 subscales, but the differences were not statistically significant.

Revised pediatric reference data for the lateral distal femur measured by Hologic Discovery/Delphi dual-energy X-ray absorptiometry

Lateral distal femur (LDF) scans by dual-energy X-ray absorptiometry (DXA) are often feasible in children for whom other sites are not measurable. Pediatric reference data for LDF are not available for more recent DXA technology. The objective of this study was to assess older pediatric LDF reference data, construct new reference curves for LDF bone mineral density (BMD), and demonstrate the comparability of LDF BMD to other measures of BMD and strength assessed by DXA and by peripheral quantitative computed tomography (pQCT). LDF, spine and whole body scans of 821 healthy children, 5-18 yr of age, recruited at a single center were obtained using a Hologic Discovery/Delphi system (Hologic, Inc., Bedford, MA). Tibia trabecular and total BMD (3% site), cortical geometry (38% site) (cortical thickness, section modulus, and strain-strength index) were assessed by pQCT. Sex- and race-specific reference curves were generated using LMS Chartmaker (LMS Chartmaker Pro, version 2.3. Tim Cole and Huiqi Pan. Copyright 1997-2006, Medical Research Council, UK) and Z-scores calculated and compared by correlation analysis. Z-scores for LDF BMD based on published findings demonstrated overestimation or underestimation of the prevalence of low BMD-for-age depending on the region of interest considered. Revised LDF reference curves were generated. The new LDF Z-scores were strongly and significantly associated with weight, body mass index, spine and whole body BMD Z-scores, and all pQCT Z-scores. These findings demonstrate the comparability of LDF measurements to other clinical and research bone density assessment modes, and enable assessment of BMD in children with disabilities, who are particularly prone to low trauma fractures of long bones, and for whom traditional DXA measurement sites are not feasible.