The association between parent's and healthcare professional's behavior and children's coping and distress during venepuncture

Objectives: Examine the association between children’s distress and coping during venepuncture with parent’s and healthcare professional’s behavior in a sample from the UK. Methods: Fifty children aged 7–16 years accompanied by a carer were videotaped while having venepuncture. Verbalizations of children, parents, and healthcare professionals were coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Results: Children’s distress was associated with child’s age, anxiety, and distress promoting behavior of adults (R2 = .91). Children’s coping was associated with age, anxiety, and coping promoting behaviors of adults (R2 = .57). Associations were stronger between healthcare professional’s behavior and child coping; and between parent’s behaviors and child distress. Empathizing, apologizing, and criticism were not frequently used by adults in this sample (<12%). Conclusion: This study supports and extends previous research showing adult’s behavior is important in children’s distress and coping during needle procedures. Clinical implications and methodological issues are discussed

Understanding needle-related distress in children with cystic fibrosis

Objective. To explore the nature and management of needle-related distress in children and adolescents with cystic fibrosis (CF). Design. Qualitative study using semi-structured interviews. Methods. Fourteen child–parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7–17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio-economic backgrounds. Interviews were transcribed and analysed using thematic analysis. Results. Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered ‘taking control’ to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle-related distress. Parent and staff influences on needle-related distress are also examined. Conclusions. Needle-related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management

Circulating cell-derived microparticles – potential markers of cardiovascular risk

Circulating cell-derived microparticles, released from cells during activation and apoptosis, are involved in inflammation, coagulation and endothelial dysfunction, all important processes in the development of cardiovascular disease. This project aimed to adapt and validate a flow cytometric assay to measure microparticles derived from various cell types, and to utilise this assay for the investigation of microparticles in healthy individuals and patients with cardiovascular-associated diseases. A lack of standardisation of pre-analytical variables has impeded the study of microparticles. Pre-analytical variables were analysed, and small changes in methodology were found to have a large impact on microparticle levels detected. Functional microparticle assays were also investigated, and results from these assays were found to be significantly associated with the quantitative results from the flow cytometry assay. Healthy individuals were recruited to establish a normal range. Interestingly, in healthy individuals, hypoxia induced by exposure to moderate altitude, was shown to cause a decrease in procoagulant, platelet-derived and red blood cell-derived microparticles. Obstructive sleep apnoea is a common syndrome, associated with an increased risk of cardiovascular disease. Microparticle levels were determined in two randomised controlled trials, investigating the impact of therapy in these patients. Initiation of treatment for six months in minimally symptomatic patients led to a decrease in procoagulant microparticles. Withdrawal of treatment for two weeks in moderate/severe patients led to an increase in endothelial-derived, granulocyte-derived and monocyte-derived microparticles. Finally circulating microparticles were investigated in patients with cardiovascular-associated conditions. Patients undergoing a dobutamine stress echocardiogram (DSE), for the identification of coronary artery disease, were studied. Patients with a negative DSE exhibited an increase in procoagulant, platelet-derived, endothelial-derived and red blood cell-derived microparticles during stress testing, which was not evident in patients with a positive DSE, suggesting that microparticles provide additional diagnostic value in this setting. In the rapidly developing field of microparticle analysis, the flow cytometric assay described in this thesis, is reproducible, flexible and correlates well with functional microparticle assays. It has also been shown to provide novel and potentially clinically relevant results in a variety of clinical conditions associated with cardiovascular disease

Landscapes of the American Past: Visualizing Emancipation

The Digital Scholarship Lab at the University of Richmond proposes Landscapes of the American Past,an online atlas of American history, as a tool for organizing and interpreting a part of the outpouring of digital materials over the past twenty years and as a tool for thinking spatially about the past. In the start-up period, we will produce "Landscapes of Emancipation," the first detailed map of emancipation yet published, and answer questions about when, where, and how emancipation emerged from the Civil War. In doing so, we will also address a question of increasing interest in the digital humanities: how can we produce maps that rely on and support open resources while at the same time creating effective and elegant visualizations that convey scholarly arguments? We will publish our findings online as a mapping application, in peer-reviewed essays, as freely accessible data and metadata, and in a white paper addressing the methodology of visualizing historical arguments

The Trials of Robert Ryland

Robert Ryland tried to behave in a generous Christian way with the African-American people among whom he lived all his life even as he presided over what he recognized was a compromised form of the church. He faced skepticism and criticism from all sides, and experienced considerable doubt, but he pressed on

An Overview: The Difference Slavery made: A Close Analysis of Two American Communities

Using digital media, we wanted to give readers full access to a scholarly argument, the historiography about it, and the evidence for it. Our early models of the article contained neat squares and lines and carefully arranged explanations of the links from one part to another. Through two sets of readings by peer reviewers and presentations to a range of audiences, we have revised our presentation and our argument while maintaining the original purpose of the article. This essay introduces the electronic article and explains its development, as well as our intentions for it

Living Monuments: Confederate Soldiers\u27 Homes in the New South (Book Review)

Review of the book, Living Monuments: Confederate Soldiers\u27 Homes in the New South by R.B Rosenburg. Chapel Hill: University of North Carolina Press, 1993

Virginia History as Southern History: The Nineteenth Century

This essay briefly surveys some of the best work that has been done over the last ten years or so in the field of nineteenth-century Virginia and southern history in general, hoping to supply inspiration for histories yet to be written

Everyman as Master (Book Review)

Ayers, Edward L. Review of Tombee: Portrait of a Cotton Planter, by Theodore Rosengarten. Charlottesville: University of Virginia Press,1987

The United States on the Eve of the Civil War

The four-year war that eventually descended on the nation seemed impossible only months before it began. Powerful conflicts pulled the United States apart in the decades before 1860, but shared interests, cultures, and identities tied the country together, sometimes in new ways. So confident were they in the future that Americans expected that the forces of cohesion would triumph over the forces of division