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Management And Outcomes Of Pediatric Necrotizing Pneumonia In The United States, Manette Ness-Cochinwala, Kaitlin Kobaitri, Paul Martinez, Balagangadhar R. Totapally

Journal of Pediatric Intensive Care

Introduction: Necrotizing pneumonia, an uncommon but serious condition in children, lacks comprehensive multicenter pediatric data. The objective was to assess treatment strategies and outcomes of necrotizing pneumonia in children. Methods: The Pediatric Health Information System was queried for patients, ages 30 days to 19 years, with lung necrosis. Children who received alteplase were compared with those who did not. The chi-square test, Mann-Whitney-U test, multivariable regression analysis, and propensity score matching were performed. Results: Out of a total of 2,177 children with necrotizing pneumonia, 59% had pleural effusion. A complex chronic condition (CCC) was present in 51% of patients. Resources …

Enteral Nutrition Practices During Non-Invasive Ventilation In Critically Ill Children: Secondary Analysis Of The Niv Dex En Study, Charlene P. Pringle, Peter Chang, Joie Cavazos, Tristan Dorn, Christine Allen, K. Leslie Avery, Torrey Baines, Samantha Gee, Nekaiya Jacobs, Jodi J. Bloxham, Elizabeth M. Brothers, Elizabeth Elliott, Shannon Faulkinberry, Emily F. Goldhar, Stephanie C. Hsu, K. Meghan Kendall, Christine Koshel, Ada T. Lin, Kristin K. Magner, Krishna S. Siruguppa, Kitman Wai, Anna Wanzenberg, Ann-Marie Brown

Journal of Pediatric Intensive Care

Introduction: Despite the widespread use of non-invasive ventilation (NIV) in pediatric intensive care units (PICUs), little has been published regarding enteral nutrition (EN) in this setting. This pre-planned secondary analysis of the Association of Enteral Nutrition and Dexmedetomidine Usage for Critically Ill Children Requiring Non-Invasive Ventilation study aimed to describe current feeding practices during NIV in a large sample, including differences in timing, energy and protein delivery across NIV modes and interfaces. Methods: Secondary analysis of a retrospective study of 1763 patients acutely supported with NIV over one year in fourteen PICUs in the United States. Results: 1065 subjects (60.4%) …

Understanding The Educational Needs Of Primary Care Providers Around Post-Intensive Care Syndrome In Pediatrics (Pics-P)- A Cross-Sectional Survey, Sarah Rubin, Katie Joy, Sarah Springer, Ericka Fink, Jessica Jarvis

Journal of Pediatric Intensive Care

Introduction: Pediatric Intensive Care Unit (PICU) survivors often experience new functional impairments after hospital discharge, known as Post-Intensive Care Syndrome in pediatrics (PICS-p). Unaddressed impairments may lead to life-long developmental delays. Primary Care Providers (PCPs) are responsible for recognizing and managing PICS-p. Understanding PCP preparedness for this role is critical to optimizing recovery after critical illness. Objectives: To characterize PCP’s 1) awareness and understanding of PICS-p, 2) access to resources for PICS-p impairments, 3) barriers to post-PICU care, 4) preferred educational strategies. Methods: Cross-sectional survey of university-affiliated PCPs from October to December 2023. An anonymous, 18-item Microsoft Forms survey was …

The Effect Of Physiologic Parameters And Vasoactive Agents On Venous Resistance, Mean Circulatory Filling Pressure, And Venous Return: Multivariable Modeling Using High-Fidelity Physiologic Data And Machine Learning, Rohit S. Loomba, Juan Farias, Enrique Villarreal, Saul Flores

Journal of Pediatric Intensive Care

Introduction: Venous parameters such as mean circulatory filling pressure, venous resistance, and venous return have largely remained theoretical concepts. In vivo characterization of these has not been frequent. This study utilized high-fidelity hemodynamic data to characterize these parameters and associated effects of vasoactive agents and other physiologic parameters in children with single ventricle parallel circulation after the Norwood operation. Methods: Physiologic data for children after the Norwood operation was collected from the T3 system, which captures data at five-second intervals. Mean circulatory filling pressure, venous resistance, and venous pressure were calculated using previously validated equations and then modeled using vasoactive …

Multicenter Quality Improvement Project To Prevent Acute Kidney Injury After Pediatric Cardiac Surgery, Jamie S. Penk, Tara C. Cosgrove, Katja M. Gist, Mathew G. Clark, Samir Q. Latifi, Caroline A. Rodeman, Angela M. Jarden, Matt Barhight, Christina Laternser, Rajit K. Basu, David S. Cooper, Santiago Borasino, Catherine D. Krawczeski, Bradley S. Marino

Journal of Pediatric Intensive Care

Objective: Acute kidney injury (AKI) is common after pediatric cardiac surgery and is associated with morbidity. We hypothesized that the incidence and severity of AKI could be decreased by a bundle of preventative interventions. Our aim was to decrease the incidence of post-operative AKI from a baseline of 41% to <30%. Methods: Prospective multicenter quality improvement project implemented in five pediatric cardiac intensive care units. The inclusion criteria were patients under 18 years of age undergoing a Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) ≥3 or Fontan operation. The bundle included: 1) Daily creatinine with AKI staging 2) Balanced fluids 3) Scheduled acetaminophen 4) Age-appropriate renal perfusion pressure 5) Nephrotoxin reduction. The primary outcome measures were incidence and severity of AKI. Results: There were 599 eligible patients in the baseline period and 480 in washout/implementation. Compared to baseline, the patients receiving the bundle underwent cardiac transplantation more frequently (10.0% versus 5.8% of total cases, p=0.01). The baseline aggregate mean incidence of any AKI was 41% and severe AKI 15%, respectively. Despite adequate bundle compliance, we observed no reduction in AKI. Conclusions: This bundle of CICU interventions did not reduce the incidence or severity of AKI in this cohort. Targeting a higher risk cohort, or starting interventions in the operating room, may be areas for future investigation.

The Development And Preliminary Exploratory Validation Of The Pediatric Delirium Scale: Assessing The Feasibility And Accessibility Of A Novel Delirium Scale, Emily C. Dodenhoff, Neha Gupta, Lauren Craig, Marjorie L. Pate, Sarah D. Petrusnek, Nianlan Yang, Kimberly Smith, Allison Wooley, Yesie Yoon, Tapan Mehta, Leslie W. Hayes

Journal of Pediatric Intensive Care

Introduction: Delirium screening and identification in the pediatric intensive care unit (PICU) can be a diagnostic challenge. Primarily, the burden of screening falls on the bedside nurses, who are juggling countless tasks throughout their shift. The nursing staff was concerned that the existing screen, Cornell Assessment for Pediatric Delirium (CAPD), detracted from workflow. The Pediatric Delirium Scale (PEDS) was developed to accurately identify delirium in children of all developmental abilities and improve nursing workflow. This is a single-center, double-blinded, preliminary exploratory validation study that assesses the feasibility and accessibility of PEDS. This study was performed in a busy 24-bed quaternary …

Barriers To Adherence Of Early Mobilization Protocols In The Picu, Katherine M. Rodriguez, Taemyn Hollis, Valerie Kalinowski, Marylouise Wilkerson

Journal of Pediatric Intensive Care

Objective: Children who survive critical illness suffer many sequelae of prolonged hospitalization. National guidelines recommend pediatric intensive care units (PICUs) employ ICU care bundles to combat acquired delirium, pain, and weakness. While use of early mobility (EM) protocols has increased in PICUs, there remain challenges with adherence. Here we describe the results of a cross-sectional survey conducted at a single center tertiary PICU. The aim of this study is to better understand perceived barriers to EM in the PICU. We hypothesized that providers would be most concerned about safety of EM. Methods: A total of 94 PICU providers were included …

Prescription Practices And Outcome Analysis Of Picu Patients At A Newly Established Tertiary Care Hospital – A Retrospective Study, Madhavi Eerike, Leo Francis Chalissery, Madhusudan Samprati, Mounika Reddy V, Chandru Elango, Kalpana Mali Ramanna, Jhilmil Gupta

Journal of Pediatric Intensive Care

Introduction: Prescription analysis studies play a crucial role in monitoring prescription patterns and establishing guidelines for effective drug delivery and healthcare management. Given the physiological differences between the paediatric and adult populations, it is essential to analyze the prescription records specifically for paediatric patients, considering their unique diseases, drugs, and dosages. Objectives: To analyse the prescribing patterns of drugs, rationality, outcomes and antimicrobial use and drugs from National List of Essential Medicines (NLEM) in Paediatric Intensive Care Unit (PICU) patients. Methodology: A retrospective study design was employed, and data was collected from medical records, including demographic information, diagnoses, drug details …

Analyzing Mortality Trends In A Uk Pediatric Critical Care Long-Stay Patient Cohort, Trishul Kothari, Nicola Kelly, Hari Krishnan Kanthimathinathan

Journal of Pediatric Intensive Care

Objectives: Long-stay patients in PICU are at-risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counselling and support. We aim to analyse the factors associated with higher mortality in the long-stay PICU patient cohort. Methods: Retrospective single centre study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a three-year study period (1st April 2017 to 31st March 2020). Outcomes analysed included in-PICU mortality, and mortality within 12 months of PICU discharge. Variables analysed for association …

Iatrogenic Withdrawal Syndrome In Critically Ill Neonates: A Review Of Mechanisms, Assessment, Management, And Prevention, Isaque Nilton Dos Santos, Carolina Teixeira Goulart Peano, Ericks Sousa Soares, Helena Iturvides Cimarosti

Journal of Pediatric Intensive Care

Considering that neonatal pain is a relevant matter given its implications and consequences, many neonates, particularly those undergoing critical care, are subjected to analgo-sedation therapies, which commonly include treatment with opioids and benzodiazepines. These drugs, however, can induce tolerance and dependency, leading to the development of the so-called iatrogenic withdrawal syndrome (IWS) which is observed following discontinuation of these therapeutic agents particularly when utilized for a prolonged period of time (>= 5 days). IWS consists of signs and symptoms manifested especially in young children, such as term and premature newborns in the neonatal intensive care unit (NICU), who are …

Regenerative Tourism And Transformative Destination Management: Developing A Framework Through The Case Of County Offaly, Yi (Alex) Yu, Mary Loonam Dr, Tony Johnston

Irish Journal of Tourism, Hospitality, Leisure and Event Research

The increasing urgency of climate change, biodiversity loss, and socio-economic transition has generated growing interest in tourism approaches that move beyond sustainability towards more transformative forms of development. While sustainable tourism has become the dominant paradigm within tourism planning and policy, it has been criticised for its emphasis on impact mitigation and its limited capacity to address systemic challenges. In response, regenerative tourism has emerged as an alternative framework that seeks to restore and enhance ecological, social, cultural, and economic systems through tourism activity.

This paper explores the potential of regenerative tourism as a framework for transformative destination management. Drawing …

School Principals’ Perspectives Regarding Successful Professional Development, Kathryn L. Bauserman, Diana Quatroche, Linda E. Martin

Journal of Educational Research and Practice

This descriptive study examined K–12 principals’ perspectives on providing and supporting school‑based professional development in one Midwestern state. Survey responses from 300 principals explored how they defined successful professional development, how they determined teacher learning needs, and the challenges they encountered. Findings revealed that principals valued professional development aligned with instructional improvement, yet many relied on their control of decision‑making processes. Professional development was commonly delivered by school or district personnel, funded through limited local and state resources, and typically offered in short sessions. Principals identified success through surveys, observations, and student achievement data while noting challenges related to funding, …

Map Of Surveys

Arlington, Texas Land Records Collection

Undated map showing original survey by Texas Title Co. with Joel Blackwell survey land highlighted

Abstract Of Title Joel Blackwell Survey 1890

Arlington, Texas Land Records Collection

Abstract of title for the Joel Blackwell survey by The Fort Worth and Tarrant County Land Title Office 17 April 1890

Vendor's Lien Note From N. W. Willett To J. T. King Jr For Part Of The Blackwell Survey Land

Arlington, Texas Land Records Collection

Vendor's Lien Note stating that N. W. Willett will pay J. T. King Jr $700 plus interest for lots 4 and 17 plus the north halves of lots 5 and 16 of the Blackwell survey land

Abstract Of Title Joel Blackwell Survey 1892

Arlington, Texas Land Records Collection

Abstract of title for the Joel Blackwell survey by The Fort Worth and Tarrant County Land Title Office 22 December 1892

Sketch Of Part Of Pilant Acres, Joel Blackwell And M. Harris Survey Lands

Arlington, Texas Land Records Collection

Undated sketch of blocks 12-17 of Pilant Acres and parts of Joel Blackwell and M. Harris survey lands

Sketch Of Part Of Pilant Acres

Arlington, Texas Land Records Collection

Undated sketch of part of Pilant Acres showing blocks 12-17 and the surrounding property

Sketch Of Part Of Joel Blackwell And M. Harris Surveys

Arlington, Texas Land Records Collection

Undated sketch of part of the Joel Blackwell and M. Harris surveys from Rattikin Title Company

Survey Plat Of The North Half Of The Joel Blackwell Survey

Arlington, Texas Land Records Collection

Undated survey plat of the northern half of the Joel Blackwell survey land, by Home Abstract Co.

Field Notes Of Joel Blackwell Survey

Arlington, Texas Land Records Collection

Survey notes of the 640 acre Joel Blackwell survey land, surveyed 3 January 1852 by A. J. Lee D. S. R.L.D. for Home Abstract Co.

Affidavit Regarding Death Of Hiram Blackwell

Arlington, Texas Land Records Collection

Affidavit of Dr. A. Sanderson stating that Hiram Blackwell, last known heir of Joel Blackwell, had died, signed 26 May 1890

Statement Of Land Taxes Due For Tract 2 Of The Blackwell Survey Land

Arlington, Texas Land Records Collection

Undated statement that no taxes are due on the 10.5 acres of tract 2 of the Blackwell survey land, except for in 1921, signed by Deputy Collector A. F. Small

Outline Of Several Survey Lands

Arlington, Texas Land Records Collection

Outline of survey lands for Blackwell 640 acre survey, M. Harris 640 acre survey, and other survey lands, signed by Ross, Herd & Ross 17 April 1898

Abstract Of Title Sol Davis Survey, Yates Brothers Addition, Block 3, 1944

Arlington, Texas Land Records Collection

Abstract of title for the south half of lots 16 and 17 of the Yates Brothers addition to the city of Arlington, part of the Sol Davis survey, by Home Guaranty Abstract Co. 24 November 1944

Partial Survey Plat Of Toliver Acres Tract 37

Arlington, Texas Land Records Collection

Survey plat of the east 100 ft of Tract 37 of the Toliver Acres addition to the city of Arlington by O. V. Di Sciullo

Affidavit Of S. R. Yates Regarding A Survey Plat

Arlington, Texas Land Records Collection

Affidavit of S. R. Yates before notary public Chas H. Rose regarding a survey plat for the city of Arlington

Abstract Of Title Sol Davis Survey, Toliver Acres, Tract 37, 1948-1954

Arlington, Texas Land Records Collection

Abstract of title for a 138 by 150 ft section of Tract 37 of the Toliver Acres addition in the Sol Davis survey land by Elliott & Waldron Abstract Companies 13 February 1948, abstract of title for a 138 by 100 ft section of the same by Stewart Title Company 14 September 1948, abstract of title for the same by Rattikin Title Company 8 November 1954

Affidavit Of Henry M. Dickson Regarding A Survey Plat

Arlington, Texas Land Records Collection

Affidavit of Henry M. Dickson before notary public [Frank Jordan] regarding a survey plat for the city of Arlington

Survey Plat Of Toliver Acres Lots 51-53

Arlington, Texas Land Records Collection

Undated survey plat of Toliver Acres with part of lots 51-53 highlighted by Rattikin title Company