Parents and procedures: a randomized controlled trial

INTRODUCTION: Previous work has shown that parents prefer to be present when their children undergo common invasive procedures, although physicians are ambivalent about parental presence. PURPOSE: To determine the effect of a parent-focused intervention on the pain and performance of the procedure, anxiety of parents and clinicians, and parental satisfaction with care. POPULATION: Children younger than 3 years old undergoing venipuncture, intravenous cannulation, or uretheral catheterization. SETTING: Pediatric emergency department of Boston City Hospital. DESIGN: Randomized controlled trial with three groups; parents present and given instructions on how to help their children; parents present, but no instructions given; and parents not present. INTERVENTION: The parents were instructed to touch, talk to, and maintain eye contact during the procedure. RESULTS: A total of 431 parents was randomized to the intervention (N = 153), present (N = 147), and not present (N = 131) groups. The groups were equivalent with respect to measured sociodemographic variables and parents' previous experience in the pediatric emergency department. No differences emerged with respect to pain (3-point scale measured by parent and clinician, and analysis of cry); performance of the procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Parents who were present were more likely to rate the pain of the children as extreme/severe (52%) in comparison to clinicians (15%, kappa .07, poor agreement) and were significantly less anxious than parents who were not present. CONCLUSION: Overall, the intervention was not effective in reducing the pain of routine procedures. Parental presence did not negatively affect performance of the procedure or increase clinician anxiety. Parents who were present were less anxious than those who were not present. CLINICAL IMPLICATION: In general, parents have indicated that they want to be present when their children undergo procedures. The results of this study challenge the traditional belief that parental presence negatively affects our ability to successfully complete procedures. We should encourage parents who want to be present to stay during procedures.     

Imitation and pantomime in high-functioning adolescents with autism spectrum disorders

A study was designed to test 2 alternative hypotheses--a symbolic hypothesis and an executive function hypotheses--for the imitation and pantomime deficits found in previous studies of autism. The subjects were 17 adolescent high-functioning subjects with autism spectrum disorders and 15 clinical comparison subjects who were matched on chronological age and verbal IQ. Meaning and sequence were manipulated in facial and manual imitation tasks. Sequence was manipulated in the pantomime and control tasks. Recognition memory and motor control tasks were matched to the experimental tasks. The results provided no support for the symbolic deficit hypothesis; meaning aided rather than hindered the performance of the group with autism. Partial support for the executive deficit hypothesis was found. There were no group differences on motor control tasks, and few on the memory control tasks, arguing against deficits in motor initiation, basic motor coordination, or visual recognition memory.     

Generation of chromosome fragment specific bovine DNA sequences by microdissection and DOP-PCR

Trends in causative organisms and sources of infection were studied in a series of 288 episodes of bacteremia in neutropenic cancer patients observed in a single institution from 1986 to 1993. The incidence of bacteremia increased significantly from 20 episodes per 1000 admissions in 1986 to 50 episodes per 1000 admissions in 1993 (p = 0.00001). Over the study period, a continuous increment in gram-positive bacteremia, which reached 81% of episodes in 1993 (p = 0.000001), was observed. Conversely, the incidence of gram-negative bacteremia remained stable. Coagulase-negative staphylococci and viridans group streptococci were the most commonly isolated pathogens. Bacteremia caused by coagulase-negative staphylococci increased from 3 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.0001), and viridans group streptococci bacteremia increased from 0 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.000001). The upward trend in gram-positive bacteremia appeared to be related to a significant increase in both intravascular catheters (p = 0.003) and oral mucositis (p = 0.003) as sources of infection. Specific strategies to prevent chemotherapy-induced mucositis and catheter-related bacteremia merit further investigations.     

Thermal design method of bayonet-tube evaporators and condensers

The paper describes an effectiveness-NTU design method of bayonet-tube evaporators and condensers. Including the effect of the wall superheat on the shell-side film coefficient, and using an energy balance on the tube, differential equations for the steady-state fluid temperatures are formulated. Because of the nonlinear nature of the governing equations, the fourth-order Runge-Kutta method is employed to the solution of the finite difference equations. The results are iterated with the combination of integration techniques. An upper bound to the numerical error being ±5% the fluid temperature distribution as well as the exchanger effectiveness are determined, and presented as a function of the Hurd number, the number of heat transfer units and the flow arrangement. For flow entering through the inner tube, the temperature distribution displays the occurrence of a minimum at a point other than the tube-tip of the exchanger. In an extension of the analysis, an effort is made to illustrate the deviation of the results obtained by uniform film coefficient from the present study, and the differences are outlined.     

Comparison of Markov model and fault tree approach in determining initiating event frequency for systems with two train configurations

This study explores the use of Markov models in some areas of systems analysis in which time evolution of the system may be a significant factor in influencing the system reliability or availability. Comparisons are made between the Markov models and the time-averaged fault tree models for determining support system failure initiating event frequency in a nuclear power plant, for both power and shutdown conditions. Factors affecting consistency between the fault tree approach and the Markov model approach are studied for systems with common two train configurations. A correlation is developed to estimate the ratio between initiator frequencies through both approaches for a two parallel component system. Insights are developed as to when time averaged and simplified fault tree models support a good approximation to the more rigorous time-dependent Markov models.     

Breaking substitution cyphers using stochastic automata

Let Λ be a finite plaintext alphabet and V be a cypher alphabet with the same cardinality as Λ. In all one-to-one substitution cyphers, there exists the property that each element in V maps onto exactly one element in Λ and vice versa. This mapping of V onto Λ is represented by a function T*, which maps any v∈V onto some λ∈Λ (i.e., T*(v)=λ). The problem of learning the mapping of T* (or its inverse (T *)^-1) by processing a sequence of cypher text is discussed. The fastest reported method to achieve this is a relaxation scheme that utilizes the statistical information contained in the unigrams and trigrams of the plaintext language. A new learning automaton solution to the problem called the cypher learning automaton (CLA) is given. The proposed scheme is fast, and the advantages of the scheme in terms of time and space requirements over the relaxation method have been listed. Simulation results comparing both cypher-breaking techniques are presented     

New substrates of papain, based on the conserved sequence of natural inhibitors of the cystatin family

A discontinuous borate/formate buffer system is presented for horizontal polyacrylamide gel electrophoresis of DNA fragments. The resolution potential of the system could be altered by changing the total monomer concentration (5-9%T), the concentration of the crosslinker piperazine diacrylamide (2-5%CPDA), as well as the concentration of formate in the gel (40-120 mM), the leading ion of the buffer system. The separation of DNA fragments would be improved by increasing the migration distance from 22 to 28 cm. This discontinuous polyacrylamide gel electrophoresis system proved highly reproducible.