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2018

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Articles 421 - 450 of 484

Full-Text Articles in Pediatrics

Fmic Annual Report 2018 | English, French Medical Institute For Mothers And Children Jan 2018

Fmic Annual Report 2018 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.


Using International, Interprofessional Service Learning To Promote Transcultural Self-Efficacy And Interprofessional Attitudes In Health Science Students, Shana L. Cerny, Lana Svien, Julie Johnson, Bethany Hansmeier Jan 2018

Using International, Interprofessional Service Learning To Promote Transcultural Self-Efficacy And Interprofessional Attitudes In Health Science Students, Shana L. Cerny, Lana Svien, Julie Johnson, Bethany Hansmeier

Journal of Occupational Therapy Education

Interprofessional teams of occupational therapy, physical therapy, physician assistant, and dental hygiene students from the University of South Dakota participated in a service-learning experience in Guatemala. Student perceptions were measured using the Interprofessional Attitudes Scale and the Transcultural Self-Efficacy Tool. Qualitative data were obtained through written reflections and discussions during the immersion component of the service-learning experience. Students reported statistically significant improvements in transcultural self-efficacy as defined by their confidence in interviewing individuals from different cultures; their values, attitudes, and beliefs regarding cultural awareness, acceptance, appreciation, recognition, and advocacy; and their knowledge on how cultural factors influence care. Slightly different …


Dexa Use For Early Detection Of Pediatric Cystic Fibrosis-Related Bone Disease, Christina Baldwin, Renallie Arcinas, Melissa Ham, Stacie Hunter, Megha Mehta, Preeti Sharma, Prigi Anu Varghese, Kelli Williams, David M. Troendle, Meghana Sathe Jan 2018

Dexa Use For Early Detection Of Pediatric Cystic Fibrosis-Related Bone Disease, Christina Baldwin, Renallie Arcinas, Melissa Ham, Stacie Hunter, Megha Mehta, Preeti Sharma, Prigi Anu Varghese, Kelli Williams, David M. Troendle, Meghana Sathe

2018

No abstract provided.


Improving Weight For Length In Infants With Cystic Fibrosis, Christina Baldwin, Lauren Lazar, Stacie Hunter, Meghana Sathe Jan 2018

Improving Weight For Length In Infants With Cystic Fibrosis, Christina Baldwin, Lauren Lazar, Stacie Hunter, Meghana Sathe

2018

No abstract provided.


The Global Impact Of The Dracma Guidelines Cow’S Milk Allergy Clinical Practice, Alessandro Fiocchi, Holger Schunemann, Ignacio Ansotegui, Amal Assa’Ad, Sami Bahna, Roberto Berni Canani, Martin Bozzola, Lamia Dahdah, Christophe Dupont, Motohiro Ebisawa, Elena Galli, Haiqi Li, Rose Kamenwa, Gideon Lack, Alberto Martelli, Ruby Pawankar, Maria Said, Mario Sánchez-Borges, Hugh Sampson, Raanan Shamir, Jonathan Spergel, Luigi Terracciano, Yvan Vandenplas, Carina Venter, Susan Waserman, Gary Wong, Jan Brozek Jan 2018

The Global Impact Of The Dracma Guidelines Cow’S Milk Allergy Clinical Practice, Alessandro Fiocchi, Holger Schunemann, Ignacio Ansotegui, Amal Assa’Ad, Sami Bahna, Roberto Berni Canani, Martin Bozzola, Lamia Dahdah, Christophe Dupont, Motohiro Ebisawa, Elena Galli, Haiqi Li, Rose Kamenwa, Gideon Lack, Alberto Martelli, Ruby Pawankar, Maria Said, Mario Sánchez-Borges, Hugh Sampson, Raanan Shamir, Jonathan Spergel, Luigi Terracciano, Yvan Vandenplas, Carina Venter, Susan Waserman, Gary Wong, Jan Brozek

Paediatrics and Child Health, East Africa

Background: The 2010 Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow’s milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment.

Objectives & methods: Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and …


The Relationship Between Iron Status, Limb Movements, And Sleep Architecture In Children, David G. Ingram Md, Gaylyn Perry Md, Zarmina Ehsan Md, Baha Al-Shawwa Md Jan 2018

The Relationship Between Iron Status, Limb Movements, And Sleep Architecture In Children, David G. Ingram Md, Gaylyn Perry Md, Zarmina Ehsan Md, Baha Al-Shawwa Md

Posters

Background

•Iron status is an important aspect of the evaluation of children with excessive limb movements during sleep. •While there is clear data in adults to support this relationship, the data in children is less well established. •We evaluated the association between iron status and limb movements during sleep in a large pediatric sample. Methods •This is a retrospective analysis of a single institution sleep program looking at all patients who underwent overnight polysomnogram and ferritin test within 24 hours of doing the sleep study between January 2015 and October 2017. •Those with sleep apnea (Central Apnea Index >5/hr or …


Hemimegalencephaly: Seizure Outcome In An Infant After Hemispherectomy, Prem Chand, Pooja Manglani, Qalab Abbas Jan 2018

Hemimegalencephaly: Seizure Outcome In An Infant After Hemispherectomy, Prem Chand, Pooja Manglani, Qalab Abbas

Department of Paediatrics and Child Health

Isolated hemimegalencephaly (iHME) is a rare form of congenital malformation of cortical development characterized by enlargement of all or part of one cerebral hemisphere. It typically presents with intractable seizures, developmental delay, contralateral hemiparesis, and hemianopia. We report a case of an 18-month-old girl who presented first with focal seizures at tenth day of life, with no other physical or behavioral abnormality. Initial EEG showed excessive sharp EEG transients more over the right hemisphere; repeated EEG showed spikes, polyspikes, sharps, and slow wave discharges predominately over the right hemisphere. MRI of the brain showed asymmetric enlargement of the right cerebral …


What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass Jan 2018

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.


Use Of Caudal Epidural Catheter In A Child With Cerebral Palsy With Prior Posterior Spine (T1-Sacrum) Fusion., Divya Dixit, Mary C. Theroux, Kirk W. Dabney, Freeman Miller Jan 2018

Use Of Caudal Epidural Catheter In A Child With Cerebral Palsy With Prior Posterior Spine (T1-Sacrum) Fusion., Divya Dixit, Mary C. Theroux, Kirk W. Dabney, Freeman Miller

Department of Anesthesiology Faculty Papers

No abstract provided.


Factors Influencing Choice Of Skilled Birth Attendance At Anc: Evidence From The Kenya Demographic Health Survey, Caroline Nyongesa, Xiaoyue Xu, John J. Hall, William Macharia, Faith Yego, Brigid Hall Jan 2018

Factors Influencing Choice Of Skilled Birth Attendance At Anc: Evidence From The Kenya Demographic Health Survey, Caroline Nyongesa, Xiaoyue Xu, John J. Hall, William Macharia, Faith Yego, Brigid Hall

Paediatrics and Child Health, East Africa

Background: In Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254–471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood.

Methods: Maternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables.

Results: Overall, 94.8% of women are likely to seek …


Problematic Child Mealtime Behavior And Caregiver Mobile Phone Use, Libby Milkovich, Meredith Dreyer, Brooke Sweeney, Sarah Nyp, Ben Black Jan 2018

Problematic Child Mealtime Behavior And Caregiver Mobile Phone Use, Libby Milkovich, Meredith Dreyer, Brooke Sweeney, Sarah Nyp, Ben Black

Posters

BACKGROUND

Problematic mealtime behaviors (PMB) (externalizing behavior at mealtime) have been seen anthropologically when adult caregivers are absorbed in their mobile phones. Parents with mobile phone problematic use (MPPU) are more likely to be absorbed in a mobile device. Neither the correlation of MPPU to PMB, nor the frequency of PMB to perceived impairment of problem behavior have been quantitatively studied.

OBJECTIVE

Evaluate correlation of caregiver MPPU and child PMB to improve understanding of the possible implications of caregiver MPPU

METHODS

Participants included caregivers of children ages 2-8 years being seen in a pediatric hospital clinic. Participants completed a survey …


Implementation Of Bedside Huddle To Improve Communication When Coordinating Care For Picu Patients With Newly Diagnosed Anterior Mediastinal Masses, Laura Mccarthy, Pam Nicklaus, Paul Sheeran, Tara Benton, Jenna Miller, Douglas C. Rivard, Melissa Gener, Susan Whitney, Keith August Jan 2018

Implementation Of Bedside Huddle To Improve Communication When Coordinating Care For Picu Patients With Newly Diagnosed Anterior Mediastinal Masses, Laura Mccarthy, Pam Nicklaus, Paul Sheeran, Tara Benton, Jenna Miller, Douglas C. Rivard, Melissa Gener, Susan Whitney, Keith August

Posters

No abstract provided.


Partnering With Inpatient Situation Awareness Screening To Improve Early Sepsis Recognition, Leslie Hueschen, Stephanie Burrus, Andrea Raymond, Charity Thompson, Lisa Carney, Jay Rilinger Jan 2018

Partnering With Inpatient Situation Awareness Screening To Improve Early Sepsis Recognition, Leslie Hueschen, Stephanie Burrus, Andrea Raymond, Charity Thompson, Lisa Carney, Jay Rilinger

Posters

Background

Early recognition of sepsis and designing a huddle process are key drivers of the Improving Pediatric Sepsis Outcomes (IPSO) collaborative. Our tertiary care, free-standing, pediatric hospital joined the IPSO collaboration in 2016. Our hospital began piloting Situation Awareness (SA) Escalation Huddles in 2016, to improve recognition of patients with clinical deterioration. The tool triggers if a patient has a high PEWS(> 5), requires initiation of hi-flow nasal cannula, or for staff/parental concern. The SA paper tool guides the communication process and steps of the huddle. Huddles include a nurse, provider, and respiratory therapist. One of the goals of the …


Significant Loss Of Blood Amino Acids And Free Carnitine In Newborns Receiving Continuous Renal Replacement Therapy (Crrt), Uttam Garg, Marita Thompson, Bradley A. Warady, Vimal Chadha Jan 2018

Significant Loss Of Blood Amino Acids And Free Carnitine In Newborns Receiving Continuous Renal Replacement Therapy (Crrt), Uttam Garg, Marita Thompson, Bradley A. Warady, Vimal Chadha

Posters

Background

•Newborns with acute kidney injury (AKI) or end-stage kidney disease (ESKD) often receive prolonged CRRT when the early initiation of peritoneal dialysis is either contraindicated or unable to be performed. •These patients often receive total parenteral nutrition (TPN) to meet their nutritional goals. •Little to no information exists on the loss of blood amino acids (AA) and carnitine during CRRT in these patients. •The objective of this study was to determine the amino acids and carnitine losses in newborns receiving prolonged CRRT and TPN. Material and Methods

•Three newborns who received prolonged (> 2 weeks) CRRT and TPN were …


Intermittent Hypoxemia In Preterm Infants, Elie G. Abu Jawdeh Jan 2018

Intermittent Hypoxemia In Preterm Infants, Elie G. Abu Jawdeh

Theses and Dissertations--Clinical and Translational Science

Intermittent hypoxemia (IH) is defined as episodic drops in oxygen saturation (SpO2). Virtually all preterm infants have IH events. Extremely preterm infants have hundreds of IH events per day. The extent of IH is not apparent clinically as accurately documenting cardiorespiratory events for day-to-day patient care management is challenging. High resolution pulse oximeters with 2 second averaging time are currently the ideal methods to measure IH. We have developed novel methods and processes to accurately and efficiently calculate an IH profile that reflects to spectrum of the problem.

The natural progression of IH is dynamic. There is low …


Medication Education In The Pediatric Rheumatology Clinic, Ashley M. Cooper, Julia G. Harris Jan 2018

Medication Education In The Pediatric Rheumatology Clinic, Ashley M. Cooper, Julia G. Harris

Posters

No abstract provided.


Decreasing Cardiac Arrests In The Pediatric Intensive Care Unit, Jeremy Affolter, Kathlyn Baharaeen, Mari Hanson, Lisa Laddish, Amy Bohm, Lindsey Bradbury, Megan Mcghee, Anne Leroy, Hannah Cunningham, Michelle Waddell, Tiffany Mullen, Kimberly Lucas, William Douglas, Angel Pope, Marita Thompson, Paul N. Bauer, Erica Molitor-Kirsch, Tara Benton, Laura Miller-Smith Jan 2018

Decreasing Cardiac Arrests In The Pediatric Intensive Care Unit, Jeremy Affolter, Kathlyn Baharaeen, Mari Hanson, Lisa Laddish, Amy Bohm, Lindsey Bradbury, Megan Mcghee, Anne Leroy, Hannah Cunningham, Michelle Waddell, Tiffany Mullen, Kimberly Lucas, William Douglas, Angel Pope, Marita Thompson, Paul N. Bauer, Erica Molitor-Kirsch, Tara Benton, Laura Miller-Smith

Posters

No abstract provided.


Characteristics Of Pediatric Antimicrobial Stewardship Programs: Current Status Of The Sharing Antimicrobial Reports For Pediatric Stewardship (Sharps) Collaborative, Chrstopher Mcpherson, Brian R. Lee, Cindy Terrill, Adam L. Hersh, Jeffrey S. Gerber, Matthew P. Kronman, Jason G. Newland Jan 2018

Characteristics Of Pediatric Antimicrobial Stewardship Programs: Current Status Of The Sharing Antimicrobial Reports For Pediatric Stewardship (Sharps) Collaborative, Chrstopher Mcpherson, Brian R. Lee, Cindy Terrill, Adam L. Hersh, Jeffrey S. Gerber, Matthew P. Kronman, Jason G. Newland

Manuscripts, Articles, Book Chapters and Other Papers

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention’s (CDC) seven core elements of a successful ASP within a large subset of US Children’s Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a …


Financial Stewardship Through Appropriate Critical Care Documentation, Shobhit Jain, Nirav Shastri, Gregory P. Conners, Irene Walsh Jan 2018

Financial Stewardship Through Appropriate Critical Care Documentation, Shobhit Jain, Nirav Shastri, Gregory P. Conners, Irene Walsh

Posters

No abstract provided.


Atrioventricular Junctional Tachycardia With Exit Block In An Adolescent, Nicholas M. Cundiff, Jeffrey A. Robinson, Bryan C. Cannon, Christopher S. Snyder Jan 2018

Atrioventricular Junctional Tachycardia With Exit Block In An Adolescent, Nicholas M. Cundiff, Jeffrey A. Robinson, Bryan C. Cannon, Christopher S. Snyder

Journal Articles: Pediatrics

No abstract provided.


Depressed Left And Right Ventricular Cardiac Output In Fetuses Of Diabetic Mothers, Jennifer Winter, Aparna Kulkarni, Mary Craft, Ling Li, Lisa K. Hornberger, David A. Danford, Shelby Kutty Jan 2018

Depressed Left And Right Ventricular Cardiac Output In Fetuses Of Diabetic Mothers, Jennifer Winter, Aparna Kulkarni, Mary Craft, Ling Li, Lisa K. Hornberger, David A. Danford, Shelby Kutty

Journal Articles: Pediatrics

INTRODUCTION: We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) to a large normal cohort.

METHODS: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters: semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD), stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO calculated. These were normalized using nonlinear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z-scores and 95% confidence limits (CL) were calculated, and compared to zero.

RESULTS: LVCO, RVCO, and parameters they were calculated from, …


Atrioventricular Junctional Tachycardia With Exit Block In An Adolescent, Nicholas M. Cundiff, Jeffrey A. Robinson, Bryan C. Cannon, Christopher S. Snyder Jan 2018

Atrioventricular Junctional Tachycardia With Exit Block In An Adolescent, Nicholas M. Cundiff, Jeffrey A. Robinson, Bryan C. Cannon, Christopher S. Snyder

Journal Articles: Pediatrics

No abstract provided.


The Relationship Between Vitamin D Status, Limb Movements, And Sleep Architecture In Children, David G. Ingram Md, Gaylyn Perry Md, Zarmina Ehsan Md, Baha Al-Shawwa Md Jan 2018

The Relationship Between Vitamin D Status, Limb Movements, And Sleep Architecture In Children, David G. Ingram Md, Gaylyn Perry Md, Zarmina Ehsan Md, Baha Al-Shawwa Md

Posters

Background

•Vitamin D deficiency has recently been posited as an important factor in the pathogenesis of restless leg syndrome.

•We evaluated the association between vitamin D deficiency and limb movements and sleep architecture in a pediatric sample.

Methods

•This is a retrospective analysis of a single institution sleep program looking at all patients who underwent overnight polysomnogram and 25-OH vitamin D within 60 days of doing the sleep study between January 2015 and October 2017. •Those with sleep apnea (Central Apnea Index >5/hr or Obstructive Apnea Hypopnea Index >2/ hr) were excluded. Results •There were a total of 83 children …


A "Passport" To Urgent Care: Medical Student Education In The Pediatric Urgent Care Setting, Emily Montgomery, David Skoglund, Tiffany Addington, Robert Riss, Amanda Montalbano Jan 2018

A "Passport" To Urgent Care: Medical Student Education In The Pediatric Urgent Care Setting, Emily Montgomery, David Skoglund, Tiffany Addington, Robert Riss, Amanda Montalbano

Posters

Background
Pediatric Urgent Care (PUC) serves as a rich environment to teach outpatient pediatric acute care. 96% of PUCs host trainees, but only 4% host medical students.1 Constraints on clinical teaching slots2 necessitate the utilization of novel settings.

Fall 2017, the University of Kansas (KU) School of Medicine approached the Division of Urgent Care at Children’s Mercy Hospital (CMH) in Kansas City, Missouri to host 3rd year medical students as part of their pediatric clerkship.

The PUC became a new site for medical student education, necessitating the development of a new curriculum.

Objective
Create a curriculum for pediatric clerkship students …


More Timely Care: Effect Of Online Queuing System Vs. Change In Hours Of Operation On Hourly Arrival Volumes, Aimy Patel, Brian R. Lee, Amanda Montalbano Jan 2018

More Timely Care: Effect Of Online Queuing System Vs. Change In Hours Of Operation On Hourly Arrival Volumes, Aimy Patel, Brian R. Lee, Amanda Montalbano

Posters

No abstract provided.


Shortening The Duration Of Antimicrobial Therapy In Uncomplicated Skin And Soft Tissue Infections, Alicia Daggett, Brandi Missel Jan 2018

Shortening The Duration Of Antimicrobial Therapy In Uncomplicated Skin And Soft Tissue Infections, Alicia Daggett, Brandi Missel

Posters

No abstract provided.


Knowledge Base Of Adolescents With Congenital Heart Disease, Pamela Finn, Mark Gelatt, Jennifer A. Marshall, Jennifer Panuco, Jenea Schmidt Jan 2018

Knowledge Base Of Adolescents With Congenital Heart Disease, Pamela Finn, Mark Gelatt, Jennifer A. Marshall, Jennifer Panuco, Jenea Schmidt

Posters

Introduction:

Most congenital heart disease [CHD] is diagnosed and treated in early childhood in designated children’s hospitals with parents responsible for decision-making and receipt of information. The adolescent assumes this role in preparation for transition to an adult congenital heart program. We studied the knowledge base of our adolescent CHD patients and their parents.

Methods:

Established patients with CHD, >11 y.o. and their parents, were independently surveyed in the outpatient clinic prior to being seen over a one-year period. Participation was voluntary. Cardiomyopathy, transplant and electrophysiology patients were excluded. Scores were assessed as full, partial or incomplete.

Results:

Most (98% …


Neonatal Safety Information Reported To The Fda During Drug Development Studies., Debbie Avant, Gerri Baer, Jason N. Moore, Panli Zheng, Alfred Sorbello, Ron Ariagno, Lynne Yao, Gilbert J. Burckart, Jian Wang Jan 2018

Neonatal Safety Information Reported To The Fda During Drug Development Studies., Debbie Avant, Gerri Baer, Jason N. Moore, Panli Zheng, Alfred Sorbello, Ron Ariagno, Lynne Yao, Gilbert J. Burckart, Jian Wang

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Relatively few neonatal drug development studies have been conducted, but an increase is expected with the enactment of the Food and Drug Administration Safety and Innovation Act (FDASIA). Understanding the safety of drugs studied in neonates is complicated by the unique nature of the population and the level of illness. The objective of this study was to examine neonatal safety data submitted to the FDA in studies pursuant to the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA) between 1998 and 2015.

METHODS: FDA databases were searched for BPCA and/or PREA studies that enrolled …


Parent Satisfaction With Outpatient Pediatric Endoscopy Procedures At University Of New Mexico Children's Hospital, Kalyan Ray Parashette, Marianne Cox, Vani Parashette, Brandon R. Bell, Pankaj Vohra, Rajmohan Dharmaraj, Richardo Castillo, Jacqueline L. Fridge Jan 2018

Parent Satisfaction With Outpatient Pediatric Endoscopy Procedures At University Of New Mexico Children's Hospital, Kalyan Ray Parashette, Marianne Cox, Vani Parashette, Brandon R. Bell, Pankaj Vohra, Rajmohan Dharmaraj, Richardo Castillo, Jacqueline L. Fridge

Pediatrics Research and Scholarship

As a part of endoscopy quality improvement (EQI) project, we decided to measure parent satisfaction about pediatric endoscopy service at University of New Mexico Children's Hospital.


The National School Lunch Program In Rural Appalachian Tennessee – Or Why Implementation Of The Healthy, Hunger Free Kids Act Of 2010 Was Met With Challenges: A Brief Report, Jodi L. Southerland, Taylor M. Dula, W. T. Dalton, Karen E. Schetzina, Deborah L. Slawson Jan 2018

The National School Lunch Program In Rural Appalachian Tennessee – Or Why Implementation Of The Healthy, Hunger Free Kids Act Of 2010 Was Met With Challenges: A Brief Report, Jodi L. Southerland, Taylor M. Dula, W. T. Dalton, Karen E. Schetzina, Deborah L. Slawson

ETSU Faculty Works

Purpose: The purpose of this study was to investigate challenges faced by high schools in rural Appalachia in implementing the Healthy, Hunger Free Kids Act of 2010 (HHFKA). Methodology: We used qualitative, secondary analysis to analyze a collection of thirteen focus groups and 22 interviews conducted in 2013-14 among parents, teachers, and high school students in six counties in rural Appalachian Tennessee (n=98). Results: Five basic themes were identified during the thematic analysis: poor food quality prior to implementation of the HHFKA school nutrition reforms; students’ preference for low-nutrient energy-dense foods; low acceptance of healthier options after implementation of the …