Consent for delivery room studies: what can be learned from perceptions of parents

Background: Obtaining ethically valid consent to participate in delivery room (DR) studies from parents facing an imminent premature birth can be challenging. This study aims to provide insight into parental experiences with and perceptions of consent for DR studies. Methods: Semistructured interviews were conducted with parents of very and extreme preterm infants. Interviews were audio-recorded, transcribed, and analyzed using the qualitative data analysis software Atlas. ti V.8.4. Results: Twenty-five parents were interviewed. Despite being in an emotional and stressful situation, most parents considered being approached for DR studies as valuable. According to parents, this was mostly due to appropriate timing and communication, compassion, and investigators not being obtrusive. Interviewed parents generally decided to accept or decline study participation based on perceived risk. Parents differed widely in how risk of specific study interventions was perceived, but agreed on the fact that parental consent is needed for DR studies that involve risk. There was no consensus among parents on deferred consent for DR studies running at our NICU. However, parents considered deferred consent appropriate for observational studies. Furthermore, it became clear that parental misunderstanding of various aspects of DR studies, including aims, the concept of randomization, and risk associated with specific interventions, was common. Conclusions: Insight into parental perceptions of consent for DR studies allowed us to determine areas where the validity of parental consent can be improved. Further research on parental perspectives for consent for DR studies will allow us to establish consent procedures that are considered both valid and valuable.Developmen

When thinking impairs sleep: Trait, daytime and nighttime repetitive thinking in insomnia

We performed two studies in individuals with sleep problems to investigate trait, daytime, and nighttime repetitive thinking as risk factors for insomnia. In Study 1, 139 participants completed questionnaires on worry, rumination, insomnia, anxiety, depression, and a sleep diary. Trait rumination and trait worry were not associated with sleep impairment. In Study 2, 64 participants completed similar measures and a daytime and nighttime sleep-related worry diary. Only nighttime sleep-related worry was consistently associated with sleep impairment. Overall, results indicate that nighttime sleep-related worry is important in the maintenance of insomnia, whereas effects of trait and daytime repetitive thinking are more benign. Treatment for insomnia can potentially be improved by focusing more on nighttime sleep-related worry

Trends in ammonia measurements in the Netherlands over the period 1993–2014

AbstractWe present measurements of atmospheric concentrations of ammonia and ammonium in the Netherlands over the period 1993–2014 and measurements of wet deposition of ammonium for 1985–2014. The various time series have been obtained at 16 monitoring stations from the Dutch National Air Quality Monitoring Network. The monitoring stations are geographically homogenously spread over the Netherlands and are equally distributed over regions with relatively low, moderate and high ammonia emission.During the period covered, changes in the monitoring have occurred. To obtain consistent time series, data are revalidated or corrected when necessary, according to current validation procedures or latest technical insights. The time series of ammonia concentrations are gap filled and time series corrected for meteorological influences are constructed.The course in the ammonia concentrations shows roughly two periods. For 1993–2004, the ammonia concentrations show a downward trend of 36%, which is statistically significant with a confidence interval (CI) of 99%. For 2005–2014, an upward trend of 19% (CI 90%) is reported. Correcting time series of ammonia concentrations for meteorological influences enhances the statistical reliability of the derived trends. This resulted in trends of −40% (CI 99%) and 24% (CI 95%) respectively. For the full period there exists no trend in ammonia concentrations due to a trend in atmospheric conditions. For 2005–2014 ammonia concentrations increased especially in springtime, while showing no change in winter months. After correcting for meteorological influences, all seasons in this period show an increase in ammonia concentrations although the increase in the spring months is still the largest.For 1993–2014 the reported ammonia emissions in the Netherlands declined in both periods with respectively 51% and 22%. The trends in emissions and ammonia concentrations correspond in the period 1993–2004 whilst over the period 2005–2014, the trends in emissions and concentrations of ammonia diverge. This divergence is for roughly a third accounted for by processes related to changes in chemical climate (see accompanying modelling paper by Wichink Kruit et al., 2016) but it is not clear what explains the remaining difference in trends.For 1993–2014, downward trends of wet deposition of ammonium and ammonium in aerosol are found to be 47% and 68%, respectively. A split into two periods is not found as is the case with the ammonia concentration. However, although statistically not significant, both wet deposition of ammonium and ammonium in aerosol show a leveling off in decline between 2005 and 2014

Ammonia emission from standing crops and crop residues : contribution to total ammonia emission in the Netherlands

Ammonia emission from standing crops and crop residues : contribution to total ammonia emission in the Netherland

Unraveling the diurnal atmospheric ammonia budget of a prototypical convective boundary layer.

We investigate diurnal variability of the atmospheric ammonia (NH3) budget over unfertilized grassland by combining observations with a conceptual atmospheric boundary layer model. Our combined approach of diurnal observations and modeling enables us to identify the contribution of the four governing processes to the NH3 diurnal cycle: surface-atmosphere exchange, entrainment, advection and chemical gas-aerosol transformations. The observations contain new NH3 flux and molar fraction measurements obtained using the Differential Optical Absorption Spectroscopy (DOAS) remote sensing technique, eliminating problems related to inlet tubing. Using strict filter criteria, 22 days with clear-sky summer conditions are selected. From this selection, we analyze a single representative day characterized by prototypical convective boundary layer conditions, using the boundary layer model constrained by meteorological observations. We design two numerical experiments to study the NH3 diurnal variability and the individual contributions of the processes governing the ammonia budget. These experiments only differ in their representation of the NH3 surface exchange. First, a fitted function through the observed NH3 flux is prescribed to the model. In the second numerical experiment, the surface flux is solved following the DEPosition of Acidifying Compounds (DEPAC) parameterization. With a prescribed surface flux, the modeled NH3 molar fraction closely fits the observations. Two regimes are identified in the NH3 diurnal cycle: the morning, where boundary layer dynamics dominate the budget through entrainment, and the afternoon, where multiple processes are of importance. A similarly close fit to the observed molar fraction is achieved in the second experiment, but we identify a mismatch between the observed and parameterized NH3 surface flux. As a result, the model requires an unrealistic budget representation to achieve this close fit, e.g. high free tropospheric NH3. Our findings on the NH3 budget, based on integrating modeling and observations, paves the way for future research on the NH3 surface-atmosphere exchange at the subdaily scales.</p

Improving Guideline Compliance and Documentation Through Auditing Neonatal Resuscitation

Developmen

Ethical dilemmas of recording and reviewing neonatal resuscitation

Developmen

Dry deposition of ammonia in a coastal dune area : Measurements and modeling

Ammonia deposition is a threat to many natural ecosystems, including coastal dune areas, because of eutrophication and acidification. Direct measurements of ammonia fluxes are nevertheless scarce. In this paper we present a full year of measurements to derive the ammonia dry deposition flux in a Dutch coastal dune ecosystem, based on the aerodynamic flux-gradient method (AGM). We found a mean ammonia flux of −7.1 ± 1.7 ng m−2 s−1, and an annual ammonia deposition flux of −132 ± 32 mol ha−1 yr−1 (equivalent to 1.8 ± 0.4 kg N ha−1 yr−1), which is at the low end of the range from estimates from literature made with inferential methods. Modeling the fluxes with the DEPAC module resulted in a mean flux of −17.0 ng m−2 s−1. The model overestimated the deposition fluxes, but diurnal variations of the fluxes derived from measurements were well captured by the model. We propose to change certain DEPAC parameters, like the leaf area index, to values more applicable for a dune ecosystem and show that this improves the agreement between model and measurements