Faculty Bibliography

The significance of nursing competence in the care of pediatric trauma patients has been well documented. Continuing education for trauma nurses is a critical component of maintaining competence in pediatric trauma care; yet, there is significant variability in the programs and resources used to support this goal. The purpose of this current study was to describe the educational activities that practicing registered nurses engage in to inform their care of injured children. A quantitative, descriptive nonexperimental research design was utilized to describe the educational programs that members of the Society of Trauma Nurses (STN) must complete to work in verified and designated trauma centers. Participants completed a survey instrument that included demographic questions, pediatric trauma educational programs required/offered by their employer, and feedback about pediatric trauma nursing education. A total of 266 STN members completed the electronic survey, reflecting a 9% response rate. Most of the participants reported that the verifying body required trauma nursing education hours (n = 187, 70.3%). The number of required courses ranged from 1 to 6, with 33 (12.4%) reporting this 3-course combination-emergency nursing pediatric course (ENPC), pediatric advanced life support (PALS), and trauma nursing core course (TNCC). The second most common combination of courses (n = 30; 11.3%) was required to take both PALS and TNCC. No significant relationship was found between verifying agency type and continuing education program required (p> .05). Trauma nursing core course was the most popular course (n = 208; 79%), followed by PALS (n = 194; 73%) and ENPC (n = 103; 38%). Participants also shared barriers to continuing education activities. It has been 10 years since pediatric trauma nursing course utilization was first explored in the literature. There continue to be significant opportunities to support nurses in continuing education activities related to the care of injured children. While barriers to accessing these types of activities sometimes exist, it is the responsibility of the pediatric trauma community to explore these challenges even further and collaborate with others interested in improving the care of injured children.

This study examined the effects of in utero exposure to maternal depression and Superstorm Sandy, a hurricane that hit metropolitan New York in 2012, on infant temperament at 6 months. Temperament was assessed using the Infant Behavior Questionnaire-Revised. Maternal depression was measured by the Edinburgh Postnatal Depression Scale. The main effects and the interaction of maternal depression and Sandy exposure on infant temperament were examined using a multivariable generalized linear model. Results show that prenatal maternal depression was associated with lower emotion regulation and greater distress. Stratification and interaction analyses suggested that the adverse effects of prenatal maternal depression on problematic temperament were amplified by in utero Sandy exposure. This study underscores the importance of providing prenatal screening and treatment for maternal depression during pregnancy while also identifying high-risk families who may have suffered from disaster-related traumas to provide necessary services. As the frequency of natural disasters may increase due to climate change, it is important to understand the consequences of in utero stress on child development and to formulate plans for early identification.

Post-stroke aphasia (PSA), which refers to the loss or impairment of language, is typically caused by left hemisphere lesions. Previous neuroimaging studies have indicated that the pathology of PSA may be related to abnormalities in functional integration. In this study, we used resting-state functional magnetic resonance imaging (rs-fMRI) to examine functional connectivity density (FCD) in PSA. We compared short- and long-range FCD between individuals with PSA (n = 17) and healthy controls (HC, n = 20). We then performed Pearson's correlation analysis on the FCD values from the affected brain regions and the speech scores in the PSA group. Compared with HCs, individuals with PSA showed increased short-range FCD in the contralesional temporal gyrus, the inferior frontal gyrus, the thalamus, the insula, and the mesial temporal gyrus [hippocampus/parahippocampus (HIP/ParaHIP)]. PSA demonstrated an increased long-range FCD in the contralesional mesial temporal gyrus (HIP/ParaHIP). PSA also displayed decreased short-range FCD in the ipsilesional part of the frontal gyrus, the caudate, the thalamus, the fusiform gyrus, and the mesial temporal gyrus (HIP/ParaHIP), and decreased long-range FCD in the ipsilesional superior temporal gyrus, the fusiform gyrus, and the mesial temporal gyrus (HIP/ParaHIP). The decreased long-range FCD in the left superior temporal gyrus in PSA subjects was positively correlated with the spontaneous speech score. The altered FCD observed due to disrupted functional connectivity after stroke may lead to language production, semantic processing, and cognitive impairments. Our findings expand previous functional studies on stroke and provide new evidence of the intraregional and interregional interactions at the voxel level in the pathophysiology of PSA.

OBJECTIVE:Findings on the influence of age and HIV on brain and cognition remain equivocal, particularly in aviremic subjects without other age or HIV-related comorbidities. We aimed to (a) examine the effect of HIV status and age on structural brain measurements and cognition, and (b) apply the machine learning technique to identify brain morphometric and cognitive features that are most discriminative between aviremic subjects with HIV on stable combination antiretroviral therapy (cART) and healthy controls. METHOD/METHODS:Fifty-three HIV-seropositive patients and 62 healthy controls underwent neuropsychological testing (executive functions, attention, memory, learning, psychomotor speed, fluency) and volumetric MRI scans. Voxel-based morphometry, ANCOVAs, machine learning, and multivariate regression were conducted to determine the between group differences in terms of relationship of HIV status, age, and their interaction on neurocognitive and structural brain measures. RESULTS:Volume and gray matter (GM) thickness of the caudate, parahippocampus, insula, and inferior frontal gyrus were smaller in seropositive subjects in comparison with healthy controls (HC). They also performed worse in complex attention and cognitive fluency tasks. Support vector machine (SVM) analysis revealed that the best between-groups classification accuracy was obtained based on cognitive scores encompassing complex attention and psychomotor speed, as well as volumetric measures of white matter and total gray matter; third, fourth, and lateral ventricles; amygdala; caudate; and putamen. Both voxel-based morphometry (VBM) and regression analysis yielded that HIV and aging independently increase brain vulnerability and cognitive worsening. CONCLUSION/CONCLUSIONS:Patients with HIV on effective cART demonstrate smaller volumetric measures and worse cognitive functioning relative to seronegative individuals. There is no interaction between HIV infection and aging. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective/UNASSIGNED:Evidence for successful and sustainable models that systematically identify and address family stress in the pediatric intensive care unit (PICU) remains scarce. Using an integrated improvement science and family engagement framework, we implemented a standardized family stress screening tool and response protocol to improve family experience and reduce family crises through the timely coordination of parent support interventions. Methods/UNASSIGNED:We conducted this improvement initiative in the 12-bed PICU of a children's hospital within a large, urban academic medical center. Our team, which included 2 family advisors, adapted a validated Distress Thermometer for use in pediatric intensive care. A co-designed family stress screening tool and response protocol were iteratively tested, refined, and implemented in 2015-2017. Process and outcome measures included screening and response reliability, parent satisfaction, and security calls for distressed families. Results/UNASSIGNED:< 0.01; 95% CI). The number of security calls for distressed families decreased by 50%. Conclusions/UNASSIGNED:The successful implementation of a co-designed family stress screening tool and response protocol led to the timely coordination of parent support interventions, the improved family perception of emotional support, and reduced family crises in the PICU.

Increased reaction time variability (RTV) is one of the most replicable behavioral correlates of attention-deficit/hyperactivity disorder (ADHD). However, this may not be specific to ADHD but a more general marker of psychopathology. Here we compare RT variability in individuals with ADHD and those with other childhood internalizing and externalizing conditions both in terms of standard (i.e., the standard deviation of reaction time) and alternative indices that capture low-frequency oscillatory patterns in RT variations over time thought to mark periodic lapses of attention in ADHD. A total of 667 participants (6-12 years old) were classified into non-overlapping diagnostic groups consisting of children with fear disorders (n = 91), distress disorders (n = 56), ADHD (n = 103), oppositional defiant or conduct disorder (ODD/CD; n = 40) and typically developing controls (TDC; n = 377). We used a simple two-choice reaction time task to measure reaction time. The strength of oscillations in RTs across the session was extracted using spectral analyses. Higher RTV was present in ADHD compared to all other disorder groups, effects that were equally strong across all frequency bands. Interestingly, we found that lower RTV to characterize ODD/CD relative to TDC, a finding that was more pronounced at lower frequencies. In general, our data support RTV as a specific marker of ADHD. RT variation across time in ADHD did not show periodicity in a specific frequency band, not supporting that ADHD RTV is the product of spontaneous periodic lapses of attention. Low-frequency oscillations may be particularly useful to differentiate ODD/CD from TDC.

We aim to investigate the effect of fronto-temporal transcranial direct current stimulation (tDCS) on the interactions among functional networks and its association with psychotic symptoms. In this pilot study, we will determine possible candidate functional networks and an adequate sample size for future research. Seven schizophrenia patients with treatment-refractory auditory hallucinations underwent tDCS twice daily for 5 days. Resting-state fMRI data and measures of the severity of psychotic symptoms were acquired at baseline and after completion of the tDCS sessions. At baseline, decreased functional network interaction was negatively correlated with increased hallucinatory behavior. After tDCS, the previously reduced functional network connectivity significantly increased. Our results showed that fronto-temporal tDCS could possibly remediate aberrant hallucination-related functional network interactions in patients with schizophrenia.

A growing body of research suggests that symptoms of autism spectrum disorder (ASD) may present differently in males and females. This study examined gender differences in ASD symptoms and developmental functioning, using the Baby and Infant Screen for Children with aUtism Traits, Part 1 (BISCUIT-Part 1) and the Battelle Developmental Inventory, 2nd Edition (BDI-2), amongst children aged 17-37 months meeting ASD diagnostic criteria (n = 1317). No gender differences were found in regards to overall symptom severity or symptom domains on the BISCUIT-Part 1 when gender groups were matched by cognitive ability. Females with ASD had greater motor deficits and less communication impairment compared to their male counterparts as measured by the BDI-2. Secondary analyses examining item endorsement patterns were also conducted. Implications of the findings are discussed.