A Randomized Trial Examining Preoperative Sedative Medication and Post-operative Sleep in Children

Study Objective Midazolam has been found to have beneficial effects on anxiety in children in the preoperative setting. Prior studies have examined various postoperative behaviors of children, but little research has examined the effects of preoperative use of midazolam with postoperative sleep. The purpose of this investigation was to compare postoperative sleep in children as a function of preoperative sedative medication use. Design This study was a 2-group randomized controlled trial. Setting Participants were recruited from Yale-New Haven Children\u27s Hospital. Patients Participants included a convenience sample of 70 children between the ages of 3 to 12 years undergoing ambulatory tonsillectomy and adenoidectomy. Interventions Children were randomly assigned to 1 of 2 groups: a control group who received preoperative acetaminophen only (n = 32) and an experimental group who received both acetaminophen and midazolam preoperatively (n = 38). Measurements Parents completed measures of postoperative behavioral recovery and a subset of children wore actigraphs to examine objective sleep data. Main Results Children who received midazolam experienced similar sleep changes compared to children in the control group. The actigraph data revealed that children who received midazolam were awake significantly less during the night compared to the control group (P= .01). Conclusion Children who received midazolam before surgery had similar postoperative sleep changes compared to children who did not receive midazolam. Further understanding of the postoperative behavioral effects of midazolam on children will help guide healthcare providers in their practice

Changing Healthcare Provider and Parent Behaviors in the Pediatric Post‐Anesthesia‐Care‐Unit to Reduce Child Pain: Nurse and Parent Training in Postoperative Stress (NP‐TIPS)

Background Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain. Methods In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents (N = 9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre‐post study design. Nurses (N = 23) who worked in the recovery room were recruited to be part of both pre‐ and post‐intervention data collection periods. Parents were recruited to be part of either the pre‐ (N = 52) or post‐intervention (N = 60) data collection periods. Nurses and parent‐child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (i.e., behaviors that may decrease child pain) and non‐desired (i.e., behaviors that may increase child pain) behaviors. Pain data was collected from the children\u27s medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post‐intervention data collection period. Results Nurses significantly increased their rate of desired behaviors by 231% (p = 0.001; Somer\u27s D = 1) and significantly decreased their rate of non‐desired behaviors by 62% (p = 0.004, Somer\u27s D = ‐0.88, 95% CI [‐1.74, ‐0.03]). Parents significantly increased their rate of desired behaviors by 124% (p = 0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b = ‐2.19, SE = 0.63, z = ‐3.46, p = .001, 95%CI [‐3.43, ‐0.95]). Conclusions The intervention was effective in changing nurse and parent behaviors as well as child pain after surgery

Revisiting a Common Measure of Child Postoperative Recovery: Development of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS)

Background The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children\u27s posthospitalization and postoperative new‐onset behavioral changes. However, the psychometric properties of the scale have not been re‐evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. Method This study used principal components analysis, a panel of experts, Cronbach\u27s alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ‐AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. Results A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ‐AS. The PHBQ‐AS demonstrated good internal consistency reliability and concurrent validity with another measure of children\u27s psychosocial and physical functioning. Conclusion Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ‐AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes

Children and Their Parents’ Assessment of Postoperative Surgical Pain: Agree or Disagree?

Objective The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. Methods This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child\u27s pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child\u27s pain lower than children rated their own pain). Results A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1–3 (30.05%–35.95%). Of those pairs in disagreement, the majority of parents overestimated their child\u27s pain on all three postoperative days, specifically such that a total of 24–26% parents overestimated their child\u27s pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. Conclusions Since parents overestimate their child\u27s postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A

Impacts of forestry planting on primary production in upland lakes from north-west Ireland

Planted forests are increasing in many upland regions world-wide, but knowledge about their potential effects on algal communities of catchment lakes is relatively unknown. Here the effects of afforestation were investigated using palaeolimnology at six upland lake sites in the north-west of Ireland subject to different extents of forest plantation cover (4-64% of catchment area). 210Pb dated sediment cores were analysed for carotenoid pigments from algae, stable isotopes of bulk carbon (δ13C) and nitrogen (δ15N), and C/N ratios. In lakes with >50% of their catchment area covered by plantations, there were two- to six-fold increases in pigments from cryptophytes (alloxanthin) and significant but lower increases (39-116%) in those from colonial cyanobacteria (canthaxanthin), but no response from biomarkers of total algal abundance (β-carotene). In contrast, lakes in catchments with <20% afforestation exhibited no consistent response to forestry practices, although all lakes exhibited fluctuations in pigments and geochemical variables due to peat cutting and upland grazing prior to forest plantation. Taken together, patterns suggest that increases in cyanobacteria and cryptophyte abundance reflect a combination of mineral and nutrient enrichment associated with forest fertilisation and organic matter influx which may have facilitated growth of mixotrophic taxa. This study demonstrates that planted forests can alter the abundance and community structure of algae in upland humic lakes of Ireland and Northern Ireland, despite long histories of prior catchment disturbance

An entangled two photon source using biexciton emission of an asymmetric quantum dot in a cavity

A semiconductor based scheme has been proposed for generating entangled photon pairs from the radiative decay of an electrically-pumped biexciton in a quantum dot. Symmetric dots produce polarisation entanglement, but experimentally-realised asymmetric dots produce photons entangled in both polarisation and frequency. In this work, we investigate the possibility of erasing the `which-path' information contained in the frequencies of the photons produced by asymmetric quantum dots to recover polarisation-entangled photons. We consider a biexciton with non-degenerate intermediate excitonic states in a leaky optical cavity with pairs of degenerate cavity modes close to the non-degenerate exciton transition frequencies. An open quantum system approach is used to compute the polarisation entanglement of the two-photon state after it escapes from the cavity, measured by the visibility of two-photon interference fringes. We explicitly relate the two-photon visibility to the degree of Bell-inequality violation, deriving a threshold at which Bell-inequality violations will be observed. Our results show that an ideal cavity will produce maximally polarisation-entangled photon pairs, and even a non-ideal cavity will produce partially entangled photon pairs capable of violating a Bell-inequality.Comment: 16 pages, 10 figures, submitted to PR

A Comprehensive Examination of the Immediate Recovery of Children Following Tonsillectomy and Adenoidectomy

Objectives Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery. Study design Observational, longitudinal study. Setting Four major pediatric hospitals in the U.S. consisting of Children\u27s Hospital of Orange County, Children\u27s Hospital of Los Angeles, Lucile Packard Children\u27s Hospital, and Children\u27s Hospital Colorado. Subjects and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic information were gathered prior to surgery, and measures of clinical, behavioral, and physical recovery were recorded immediately following and up through two weeks after surgery. Results Pain following T&A was clinically significant through the first post-operative week and nearly resolved by the end of the second week. Negative behavioral changes were highly prevalent after surgery (75.6% of children at Day 0) through the first week (63.9% at Week 1), and over 20% of children continued to evidence new onset negative behavioral changes at two weeks post-operatively. Children were rated as experiencing significant functional impairment in the immediate three days following surgery and most children returned to baseline functioning by the end of the second week. Conclusions Results of this study suggest that children show immediate impairment in functioning and experience clinically significant pain throughout the first week following T&A, and new onset maladaptive behavioral changes persisting even up to the two-week assessment period

Prototype finline-coupled TES bolometers for CLOVER

CLOVER is an experiment which aims to detect the signature of gravitational waves from inflation by measuring the B-mode polarization of the cosmic microwave background. CLOVER consists of three telescopes operating at 97, 150, and 220 GHz. The 97-GHz telescope has 160 feedhorns in its focal plane while the 150 and 220-GHz telescopes have 256 horns each. The horns are arranged in a hexagonal array and feed a polarimeter which uses finline-coupled TES bolometers as detectors. To detect the two polarizations the 97-GHz telescope has 320 detectors while the 150 and 220-GHz telescopes have 512 detectors each. To achieve the target NEPs (1.5, 2.5, and 4.5x10^-17 W/rtHz) the detectors are cooled to 100 mK for the 97 and 150-GHz polarimeters and 230 mK for the 220-GHz polarimeter. Each detector is fabricated as a single chip to ensure a 100% operational focal plane. The detectors are contained in linear modules made of copper which form split-block waveguides. The detector modules contain 16 or 20 detectors each for compatibility with the hexagonal arrays of horns in the telescopes' focal planes. Each detector module contains a time-division SQUID multiplexer to read out the detectors. Further amplification of the multiplexed signals is provided by SQUID series arrays. The first prototype detectors for CLOVER operate with a bath temperature of 230 mK and are used to validate the detector design as well as the polarimeter technology. We describe the design of the CLOVER detectors, detector blocks, and readout, and present preliminary measurements of the prototype detectors performance.Comment: 4 pages, 6 figures; to appear in the Proceedings of the 17th International Symposium on Space Terahertz Technology, held 10-12 May 2006 in Pari