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.     

Galanin-receptor ligand M40 peptide distinguishes between putative galanin-receptor subtypes

The galanin-receptor ligand M40 [galanin-(1-12)-Pro3-(Ala-Leu)2-Ala amide] binds with high affinity to [mono[125I]iodo-Tyr26]galanin-binding sites in hippocampal, hypothalamic, and spinal cord membranes and in membranes from Rin m5F rat insulinoma cells (IC50 = 3-15 nM). Receptor autoradiographic studies show that M40 (1 microM) displaces [mono[125I]iodo-Tyr26]galanin from binding sites in the hippocampus, hypothalamus, and spinal cord. In the brain, M40 acts as a potent galanin-receptor antagonist: M40, in doses comparable to that of galanin, antagonizes the stimulatory effects of galanin on feeding, and it blocks the galaninergic inhibition of the scopolamine-induced acetylcholine release in the ventral hippocampus in vivo. In contrast, M40 completely fails to antagonize both the galanin-mediated inhibition of the glucose-induced insulin release in isolated mouse pancreatic islets and the inhibitory effects of galanin on the forskolin-stimulated accumulation of 3',5'-cAMP in Rin m5F cells; instead M40 is a weak agonist at the galanin receptors in these two systems. M40 acts as a weak antagonist of galanin in the spinal flexor reflex model. These results suggest that at least two subtypes of the galanin receptor may exist. Hypothalamic and hippocampal galanin receptors represent a putative central galanin-receptor subtype (GL-1-receptor) that is blocked by M40. The pancreatic galanin receptor may represent another subtype (GL-2-receptor) that recognizes M40, but as a weak agonist. The galanin receptors in the spinal cord occupy an intermediate position between these two putative subtypes.     

High-performance surface-micromachined inchworm actuator

This work demonstrates a polycrystalline silicon surface-micromachined inchworm actuator that exhibits high-performance characteristics such as large force (/spl plusmn/0.5 millinewtons), large velocity range (0 to /spl plusmn/4.4 mm/sec), large displacement range (/spl plusmn/100 microns), small step size (/spl plusmn/10, /spl plusmn/40 or /spl plusmn/100 nanometers), low power consumption (nanojoules per cycle), continuous bidirectional operation and relatively small area (600 /spl times/ 200/spl mu/m/sup 2/). An in situ load spring calibrated on a logarithmic scale from micronewtons to millinewtons, optical microscopy and Michelson interferometry are used to characterize its performance. The actuator consists of a force-amplifying plate that spans two voltage-controlled clamps, and walking is achieved by appropriately sequencing signals to these three components. In the clamps, normal force is borne by equipotential rubbing counterfaces, enabling friction to be measured against load. Using different monolayer coatings, we show that the static coefficient of friction can be changed from 0.14 to 1.04, and that it is load-independent over a broad range. We further find that the static coefficient of friction does not accurately predict the force generated by the actuator and attribute this to nanometer-scale presliding tangential deflections.     

Mixture priors for Bayesian performance monitoring 1: fixed-constituent model

This paper addresses the problem of assessing the current performance of a system, given that performance can change over time. In many problems of interest, although a significant body of historical evidence is available, current performance information is too sparse to be the sole basis for an assessment of how well the system is currently performing. Therefore, it is desirable to apply current data within a Bayesian framework, making use of a broader body of evidence. However, both noninformative priors and simple informative priors have drawbacks for this application. The present work shows that ‘mixture’ priors have relatively desirable properties for performance assessment. These properties are illustrated using a simple example in assessment of reliability performance. It is also shown that one implementation of the mixture prior (the ‘fixed-constituent model’) is formally equivalent to methods used in signal detection, statistical decision rules in medical diagnosis, and many other applications. Building on the medical analogy, the potential benefits of an integrated treatment of reliability data and inspection results are illustrated. A companion paper develops a more sophisticated implementation of the mixture prior (the ‘variable-constituent model’), and extends the treatment to more complex examples.     

Parametric estimation of time-dependent failure rates for probabilistic risk assessment

This article describes a method for modeling a time-dependent failure rate, based on field data from similar components that are repeatedly restored to service after they fail. The method assumes that the failures follow a Poisson process, but allows many parametric models for the time-dependent failure rate λ(t). Ways to check many of the assumptions form an important part of the method. When the assumptions are satisfied, the maximum likelihood estimate of λ(t) is approximately lognormal, and this lognormal distribution is appropriate to use as a Bayesian distribution for λ(t) in a probabilistic risk assessment.     

Replacement of lateral line sensory organs during tail regeneration in salamanders: identification of progenitor cells and analysis of leukocyte activity

It has been proposed that supporting cells may be the progenitors of regenerated hair cells that contribute to recovery of hearing in birds, but regeneration is difficult to visualize in the ear, because it occurs deep in the skull. Hair cells and supporting cells that are comparable to those in the ear are present in lateral line neuromasts, and in axolotl salamanders these cells are accessible to microscopic observation in vivo. After amputation of a segment of the tail that contains neuromasts, cells from the posteriormost neuromast on the tail stump divide rapidly and form a migratory regenerative placode. The cells of the regenerative placode represent a lineage that eventually produces both hair cells and supporting cells in replacement neuromasts. We sought to identify the progenitors of the regenerative placode by using differential interference contrast microscopy combined with time-lapse video recording in living axolotl salamanders. In response to amputation, the mantle-type supporting cells at the posteroventral edge of the neuromast that is nearest to the wound increased their frequency of cell division, and gave rise to the first cells of the placode. The increase in mitotic activity of mantle-type supporting cells was accompanied by an unexplained decrease in the frequency of divisions in the same neuromast's population of internal supporting cells. The time-lapse records suggested that the changes in the mitotic activity of supporting cells might have been linked to the presence of phagocytic leukocytes in the vicinity of the neuromast that was nearest to the wound. Leukocytes were evenly distributed around control neuromasts, but during regeneration leukocyte activity increased significantly in the vicinity of the posterior half of the posteriormost neuromast. The redistribution of leukocytes occurred early in the regenerative response, but a causal role for the leukocytes has not been conclusively established. It is possible that the leukocytes could contribute to the formation of the regenerative placode at that location by breaking down the glycocalyx that ensheaths the outermost cells of the neuromast, or through the secretion of mitogenic growth factors.     

Acute nicotinic blockade produces cognitive impairment in normal humans

Single oral doses of the central and peripheral nicotinic antagonist mecamylamine were administered to healthy young normal males in doses of 5, 10, and 20 mg in a placebo-controlled, double-blind study. The 20 mg dose caused a significant increase in errors in the learning condition of the Repeated Acquisition task, producing a slower acquisition curve. The lower doses produced less errors, but more than in the placebo condition. There was no effect of drug on the performance component (retrieval of previously learned information). On the recognition memory task, dose-related increases in false-alarms during the delay period were seen, with little effect on misses or hits. Reaction time measures suggested a dose-related slowing of RT on several tasks. Behavioral effects were minimal and physiologic measures were consistent with dose-related ganglionic blockade. We interpret these results to indicate that acute blockade of nicotinic receptor function can produce measurable and significant cognitive impairment, even in non-smoking normals.