Beyond the drugs: Non-pharmacological strategies to optimize procedural care in children

Purpose of review Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of non-pharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation. Recent findings Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care. Summary Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-Appropriate verbal and nonverbal expression by professionals. Next, age-Appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Shapes of molecular lines from first principles (proposal for constructing line-shape databases from ab initio calculations)

International audienceA proper treatment of non-Voigt line-shape effects is crucial to reliably interpret and reconstruct accurate molecular spectra as well as to reduce the systematic errors in atmospheric measurements of the Earth and other planets. This fact has stimulated development of a new structure of modern spectroscopic databases [1-3] and incorporation of an extensive set of new line-shape parameters [4]. It turned out, however, that the most challenging issue is to determine the values of these parameters for a wide range of pressures and temperatures covering all the bands and branches. Currently a set of available experimental data is relatively sparse and even if the experimental data can be reliably fitted and reproduced with the non-Voigt line-shape model then their extrapolations to other transitions and other thermodynamic conditions would result in very large errors [4]. Following [5, 6] we present our proposal for overcoming this difficulty by performing a set of ab initio line-shape calculations. We calculate from first principles the phase-/state-changing contribution by full quantum-scattering calculations [7-9] and velocity-changing one from the Boltzmann collisional operator based on the billiard-ball approximation [10, 11]. After validation with experimental spectra for several particular lines we will be able to generate a complete dataset of ab initio line-shape parameters for a given molecular system. Finally, they will be projected [4] on a simple structure of the quadratic correlated speed-dependent hard collision profile [12, 13] also called the Hartmann-Tran profile [14], hence making them ready to be included into the new structure [1, 2] of the HITRAN database [15]. To validate our concept, we chose H2 perturbed by helium which, on one hand, is the simplest possible system for such studies while, on the other hand, it is relevant for the studies of the atmospheres of gas giants and hence required to be stored in the spectral line databases. Our preliminary results for pure rotational and fundamental bands demonstrate that our ab initio approach not only well reproduces experimental spectra, but can also be used to validate the potential energy surfaces available in the literature [8]. In the next step we will repeat these calculations for higher H2 vibrations with an extended version of the recent highly accurate PES [16]. A positive validation of our calculations will open a way for generating the first complete ab initio dataset of the line-shape parameters for a particular molecular system. In a long-term perspective we would like to focus on the CO-N2 system, which is not only relevant for the investigations of Earth's atmosphere but can also be a feasible objective of ab initio studies

Evaluation of different parameterizations of temperature dependences of the line-shape parameters based on ab initio calculations: Case study for the HITRAN database

International audienceTemperature dependences of molecular line-shape parameters are important for the spectroscopic studies of the atmospheres of the Earth and other planets. A number of analytical functions have been proposed as candidates that may approximate the actual temperature dependences of the line-shape parameters. In this article, we use our ab initio collisional line-shape calculations for several molecular systems to compare the four temperature ranges (4TR) representation, adopted in the HITRAN database [J. Quant. Spectrosc. Radiat. Transfer 2017;203:3] in 2016, with the double-power-law (DPL) representation. Besides the collisional broadening and shift parameters, we consider also the most important line-shape parameters beyond Voigt, i.e., the speed dependence of broadening and shift parameters, and real and imaginary parts of the complex Dicke parameter. We demonstrate that DPL gives better overall approximation of the temperature dependencies than 4TR. It should be emphasized that DPL requires fewer parameters and its structure is much simpler and more self-consistent than the structure of 4TR. We recommend the usage of DPL representation in HITRAN, and present DPL parametrization for Voigt and beyond-Voigt line profiles that will be adopted in the HITRAN database. We also discuss the problem of the Hartmann-Tran profile parametrization in which the correlation parameter, η, and frequency of the velocity-changing collisions parameter, ν vc , diverges to infinity when collisional shift crosses zero; we recommend a simple solution for this problem

A Game-theoretic Model of Attention in Social Networks

We model the economics of producing content in online social networks such as Facebook and Twitter. We propose a game-theoretic model within which we quantify inefficiencies from contributions by strategic users in online environments. Attention and information are assumed to be the main motivation for user contributions. We treat attention as a mechanism for sharing the profit from consuming information and introduce a general framework for analyzing dynamics of contributions in online environments. We analyze the proposed model and identify conditions for existence and efficient computation of pure-strategy Nash equilibrium. We prove a bicriteria bound on the price of anarchy; in particular we show that the social welfare from central control over level of contribution by users is no larger than the social welfare from strategic agents with twice as large consumption utilities. We then construct and analyze a family of production games that have an arbitrarily large price of anarchy. We also prove nonrobustness of the price of anarchy for a particular instance of the introduced family, establishing a distinction between the games studied here and network congestion games.

The needs of parents of hospitalized children in Australia

The aim of this study was to compare the perceptions of needs held by parents of hospitalized children with those held by the staff caring for them. Family-centred care is a central tenet of paediatrics and should encompass all aspects of the child and family's experience of hospitalization. Important to this are the needs of parents when their children are hospitalized. A widely used and validated tool was used with a convenience sample in paediatric facilities in a children's hospital in Australia. Some differences were found between parents and staff for scores for perceived importance of the 51 needs included in the questionnaire, and whether or not they were being met satisfactorily during children's hospital admission, although there were no consistent patterns. Parents declared themselves more independent than the staff perceived them to be. These findings facilitate improvements in communication between parents and staff and can be included in education programmes for both

Pain assessment tools: children's nurses' views

The persistence of inadequate treatment of pain in children could be due to lack of knowledge and nurses’ failure to assess and manage pain effectively. It is recognized that effective pain assessment leads to more satisfied children and families. This study explored children’s nurses’ views on the use of pain assessment tools in a tertiary referral centre. Almost two-thirds of nurses did not have a preference for a pain assessment tool, but nearly three-quarters of nurses surveyed agreed that the introduction of pain assessment tools would improve documentation. When nurses were asked how much time they needed for education on these tools, 83 percent wanted only two hours, although almost half stated lack of knowledge or education as the main obstacle to use of a pain assessment tool. The inconsistencies in these replies could reflect the conflicting demands between the nurses’ need to increase their knowledge of pain assessment while managing a heavy workload