A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department

<p>Abstract</p> <p>Background</p> <p>Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population.</p> <p>Methods</p> <p>The study design was a double (sucrose) and single blind (pacifier), placebo-controlled randomized trial – factorial design carried out in a pediatric emergency department. The study population was infants, aged 0 – 6 months. Eighty-four patients were randomly assigned to one of four groups: a) sucrose b) sucrose & pacifier c) control d) control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline. Secondary outcome measures: crying time and heart rate change from baseline.</p> <p>Results</p> <p>Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant), crying times (statistically significant) but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p < 0.0171) (0–1 month) and 123.9 seconds (p < 0.0029) (1–3 month). For subgroup age > 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age.</p> <p>Conclusion</p> <p>Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0–3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN15819627</p

”I will achieve my goals where I wanna go” - En kvalitativ etnografisk studie om delaktighet och hopp för personer med funktionshinder i Sydafrika.

The aim of the study has been to explore what participation and hope means for persons with disabilities living in an institution called Horizon House, in Stellenbosch South Africa. The aim has also been to discover the South African approach to disability and how Horizon House fits into this approach. Horizon House is an institution and a protective workplace in Stellenbosch for adults whose main impairment is of an intellectual nature but there are also physical and emotional disabilities. Another aim has been to explore the perspectives of the residents. The research questions of the study are: • What does participation imply for the residents of Horizon House? • What does Hope represent for the residents of Horizon House? • What importance can hope have for people with disabilities, in their approach towards increased participation? We travelled to South Africa during a two week period in March 2009, where we participated at the protective workplace of Horizon House. The study was carried out as a semi structural qualitative interview together with participant observations and photography. The theoretical framework of the study has been based on the concepts of hope and participation. The study shows that social fellowship and activity have an important role in the meaning of participation for the residents. They described friends, love and caring for each other as important aspects in their everyday life. The study also shows the challenges and the complexity it can mean to be living in a context with other people and working together. The protective workplace is compulsory for all the residents, although the study has also shown aspects of self-determining and residents being proud over their work. One of Horizon House´s missions are to provide hope to the residents and to make training and provision of work opportunities available. The study shows that hope for the residents revolves around goals and future visions, acceptance, faith and dreams. The study also shows that there are some parallels found between hope and participation but the study can not demonstrate that hope has a significant meaning in the approach towards increased participation

Metod för insamling och rekonstruktion av icke-kartesisk 3-D fMRI

The PRESTO sequence is a well-known 3-D fMRI imaging sequence. In this sequence the echo planar imaging technique is merged with the echo-shift technique. This combination results in a very fast image acquisition, which is required for fMRI examinations of neural activation in the human brain. The aim of this work was to use the basic Cartesian PRESTO sequence as a framework when developing a novel trajectory using a non-Cartesian grid. Our new pulse sequence, PRESTO CAN, rotates the k-space profiles around the ky-axis in a non-Cartesian manner. This results in a high sampling density close to the centre of the k-space, and at the same time it provides sparser data collection of the part of the k-space that contains less useful information. This "can- or cylinder-like" pattern is expected to result in a much faster k-space acquisition without loosing important spatial information. A new reconstruction algorithm was also developed. The purpose was to be able to construct an image volume from data obtained using the novel PRESTO CAN sequence. This reconstruction algorithm was based on the gridding technique, and a Kaiser-Bessel window was also used in order to re-sample the data onto a Cartesian grid. This was required to make 3-D Fourier transformation possible. In addition, simulations were also performed in order to verify the function of the reconstruction algorithm. Furthermore, in vitro tests showed that the development of the PRESTO CAN sequence and the corresponding reconstruction algorithm were highly successful. In the future, the results can relatively easily be extended and generalized for in vivo investigations. In addition, there are numerous exciting possibilities for extending the basic techniques described in this thesis

Low dimensional Zinc- and Copper Oxides and their Electronic, Vibrational and Photocatalytic Properties

Pollution of water resources is a growing problem in the world and this has drawn the attention to photocatalysis, which is an emerging technology for water purification. In this thesis, low dimensional zinc oxide and copper oxides, which are promising photocatalytic materials, have been studied. In the initial work, an approach for determining the crystal orientation in ZnO nanomaterials was developed based on polarized Raman spectroscopy. The approach was extended to non-polarized Raman spectroscopy for convenient crystal orientation determination. The results were corroborated by density functional theory (DFT) calculations providing a full vibrational mode analysis of ZnO, including higher-order Raman scattering. Photocatalyst materials based on both ZnO and copper oxides were synthesized, starting with visible light absorbing Cu2O prepared by low temperature thermal oxidation of flat and 3D structured Cu-foils. Defect induced Raman scattering revealed Raman activity in modes that are only IR active or optically silent in pristine Cu2O, with mode assignments supported by DFT calculations. Experiment with solar light illuminated Cu2O showed efficient degradation of organic water-soluble molecules and degradation rates could be further increased by 3D structuring into nanopillars. With the aim of creating a combined photocatalyst that use favourable properties from several materials, nanoparticles of ZnO were synthesized and deposited onto Cu2O, Cu4O3 and CuO. ZnO of sufficiently small size exhibit quantum confinement, which allowed for tuning of the electronic and optical properties of ZnO and this was utilized for energy level alignment in heterojunctions with copper oxides. The heterojunctions were shown to facilitate charge transfer which improved the photocatalytic properties of the dual catalysts compared to the single components. The quantum confinement effects in ZnO nanoparticles were further investigated by more detailed electrochemical measurements. The main finding was that quantum confinement results in a large decrease in the available electronic density of states which has clear implications on the capacitance and photon absorption in the material. Raman spectroscopy has been a central tool in all work, and the thesis ends with a study that goes through and explain spurious Raman signals. The contribution shows how to identify and avoid spectral artefacts and other light generating processes that compete with the Raman signal and guide the acquisition of good quality spectra

Offentlig upphandling - och dess utmaningar : Hur styr Landstinget i Uppsala Län, vårdenheten Uppsala Närakut?

I denna uppsats har författarna studerat hur Landstinget i Uppsala Län styr och kontrollerar Uppsala Närakut. Syftet är att beskriva på vilket sätt detta sker och på vilka grundförutsättningar styrningssättet baseras. Den vetenskapliga teorin, som denna uppsats vilar på, består av de generella teorierna kring definiering av styrning och kontroll som härstammar från Forsell &amp; Ivarsson Westerberg (2007) samt (Kotterman 2006). De mer specifika teorierna berör dels agent- och stewardshipteorierna, presenterade av Eisenhardt (1989), Davis et al. (1997) samt Van Slyke (2007) och dels styrning via incitament och informationsövervakning av Merchant &amp; Van der Stede (2007) respektive (Lambright 2008). Dessa teorier behandlar kontraktsstyrning och hjälper oss att förankra förutsättningen för styrningen med relevant teori. Det empiriska materialet, bestående av dels formella avtal och uppföljningsdokument för fallet i fråga samt en personlig intervju med en ansvarig utredare vid Landstinget i Uppsala Län, har sedan ställts i ljuset av denna teori. Det formella empiriska materialet består av själva avtalskontraktet och har av författarna sållats, så att endast material relevant för uppsatsens syfte presenteras. Detta material har sedan analyserats utifrån den presenterade vetenskapliga teorin och satts i relation till uppsatsens syfte. Resultatet i denna studie är att Landstinget i Uppsala län styr Uppsala Närakut genom mål och kontraktsstyrning där yttre belöningar ska motivera enheten att sträva mot Landstingets mål. För att kontrollera enheten använder sig Landstinget av ett befäst ersättningsbaserat datorsystem för vård och patientregistrering samt administration.  De förlitar sig även på Uppsala Närakut i tron att god vilja skapar ömsesidig tillit genom goda relationer vilket motiverar enheten genom inre belöningar att lämna korrekta uppgifter

Det är ingenting naturligt som kommer : En undersökning gällande elever i år 9 och deras uppfattningar om svenska språkets grammatik

Examensarbetets syfte är att öka förståelsen för elevers uppfattningar om undervisning i svenska språkets grammatik. De övergripande frågeställningarna är: Vad säger elever i år 9 om undervisningen i svenska språkets grammatik? Hur definierar eleverna grammatik? Hur vill eleverna att undervisningen i svenska språkets grammatik utformas? Den teoretiska utgångspunkten i examensarbetet är det sociokulturella perspektivet, vilket innebär att det huvudsakliga lärandet sker i en social miljö och att språket är en central del. Som metod användes gruppintervjuer med sju grupper om tre elever i varje grupp. Eleverna kommer från två olika skolor i en mellansvensk kommun. Resultatet av examensarbetet är att elevers uppfattningar om grammatik är övervägande negativ. Trots detta ansåg de flesta grammatiken som både viktig och nödvändig. Eleverna är överens om att grammatikundervisningens utrymme är litet och de flesta av eleverna påpekar även att grammatikmomentet hade störst plats under år 4-6. Några av eleverna eftersökte repetition medan andra framhävde att den därmed skulle bli överflödig. Om de flesta av eleverna fick bestämma skulle undervisningen baseras på exempel från verkligheten. Den skulle även delas upp i mindre delar för att underlätta inlärning då eleverna påpekade att grammatikmomentet är omfattande