This study examined adult hospitalized patients’ responses to wound care pain and its treatment. Wound care included dressing change, packing, irrigation, and debridement. The subjective experience of pain intensity was measured with a numeric rating scale (NRS) prior to, immediately after, and 10 minutes after completion of the procedure. The sample was composed of 412 subjects. Most were male (52.3%), white (73.9%), had one wound (59.5%), and had undergone surgery (73.9%). When pain intensity was compared over time, pain intensity was greatest (NRS 4.4, SD 3.2) during the procedure (p < .023), and nonsurgical patients experienced significantly greater pain than surgical patients (p = .002)(NRS 5.3, SD 3.0, NRS 4.1, SD3.2, respectively). Most patients underwent multiple wound care procedures. When the pain intensity of undergoing only a dressing change (n = 61), only packing (n = 41), or ≥2 procedures (n = 258) was examined by whether subjects had undergone surgery or no surgery, nonsurgical patients reported greater pain intensity with dressing change (p < .001) and ≥2 procedures (p < .001). Few subjects received analgesics (7.3% surgical patients 5.9% nonsurgical); there was no difference by group in the amount of opioid administered (p = .821). Sedatives and NSAIDS were rarely used. Treatment with pain medication was examined over time. Those with least pain received significantly less pain medication when compared with those who received premedication only and those who received medication prior to and during the procedure (p < .05). Findings show wound care is painful and wound care pain is undertreated. Further research is needed to address the effect of pain on wound-related patient outcomes and strategies to minimize pain. Funded by the AACN, K. Puntillo, PI

The Health Service Circular 2002/009: Better Blood Transfusion ‐ Appropriate Use of Blood highlights the essential need to provide transfusion education to all staff involved in the transfusion process. Hospitals have made significant progress to ensure transfusion training is in place. This activity has largely been co‐ordinated by the role of the Transfusion Practitioner. However some staff groups and clinical areas remain difficult to access. In the Serious Hazards of Transfusion (SHOT) report 2004, SHOT recommend the e‐learning package ‘Learnbloodtransfusion’ (LBT). In an attempt to offer the opportunity to provide a blended approach to education and compliment existing training initiatives, the National Blood Service, with support from the National Blood Transfusion Committee purchased an access agreement from the Scottish National Blood Transfusion Service to provide access to the package and the On‐line Recording and Assessment System (ORAS) to hospitals in England and North Wales. A pilot commenced in June 2005 and included five NHS hospitals and one private hospital. Nominated administrators from these sites attended a workshop to better understand the features of and how to use the package. The pilot sites utilised LBT for a period of 3 months and were asked to record any challenges to implementation, difficulties utilising the package and any tips for implementation. Pilot sites completed evaluation forms and attended an evaluation meeting September 2005. Following feedback changes were made to the supportive documentation provided and the implementation process. In November 2005 the package and ORAS were launched in England and North Wales. Feedback from the pilot process showed the main challenge for hospitals was how to establish e‐learning as an integral part of transfusion education within their organisation. Since the purchase of the access agreement and launch of the LBT package, 119 organisations have expressed an initial interest in the package. 33 organisations have gone on to fully implement the package. For 17 further organisations the implementation process is ongoing. The learnbloodtransfusion e‐learning package provides a flexible, free, easy to utilise, evidence based education tool for hospitals to use to supplement existing programmes for transfusion training.

BACKGROUND: Wound care (WC) is an important part of treatment for hospitalized patients with wounds. There is a paucity of data about the type or amount of pain patients experience during WC.OBJECTIVES: The purpose of this study is to describe patients' (n = 412) WC-related pain perceptions and responses, examine the relationships between patients' WC pain and demographic variables, and describe the distress associated with WC.METHODS: A repeated-measures design was used to examine pain before, during, and after WC in hospitalized patients (n = 412) with wounds healing by secondary intention.RESULTS: Pain intensity was greatest during WC. it was most frequently described as tender, sharp, stinging, aching, and stabbing. Behaviors that occurred most often were no verbal response, no body movement, grimace, and complaints of pain. There were no differences in pain between genders. Nonwhites had significantly greater WC pain than whites. Pain during the procedure was the same in younger and older patients, and procedural distress was mild.CONCLUSION: Patients experience pain and distress with WC. Some behaviors and words consistently describe WC pain. Further work is warranted to refine pain assessment and management in patients undergoing WC procedures.

Objective Patients frequently display behaviors during procedures that may be pain related. Clinicians often rely on the patient's demonstration of behaviors as a cue to presence of pain. The purpose of this study was to identify specific pain-related behaviors and factors that predict the degree of behavioral responses during the following procedures: turning, central venous catheter insertion, wound drain removal, wound care, tracheal suctioning, and femoral sheath removal. Design Prospective, descriptive study. Setting Multiple units in 169 hospitals in United States, Canada, England, and Australia. Patients A total of 5,957 adult patients who underwent one of the six procedures. Interventions None. Measurements and Main Results A 30-item behavior observation tool was used to note patients' behaviors before and during a procedure. By comparing behaviors exhibited before and during the procedure as well as behaviors in those with and without procedural pain (as noted on a 0–10 numeric rating scale), we identified specific procedural pain behaviors: grimacing, rigidity, wincing, shutting of eyes, verbalization, moaning, and clenching of fists. On average, there were significantly more behaviors exhibited by patients with vs. without procedural pain (3.5 vs. 1.8 behaviors; t = 38.3, df = 5072.5; 95% confidence interval, 1.6–1.8). Patients with procedural pain were at least three times more likely to have increased behavioral responses than patients without procedural pain. A simultaneous regression model determined that 33% of the variance in amount of pain behaviors exhibited during a procedure was explained by three factors: degree of procedural pain intensity, degree of procedural distress, and undergoing the turning procedure. Conclusions Because of the strong relationship between procedural pain and behavioral responses, clinicians can use behavioral responses of verbal and nonverbal patients to plan for, implement, and evaluate analgesic interventions.

BACKGROUND Little is known about the painfulness of procedures commonly performed in acute and critical care settings. OBJECTIVE To describe pain associated with turning, wound drain removal, tracheal suctioning, femoral catheter removal, placement of a central venous catheter, and nonburn wound dressing change and frequency of use of analgesics during procedures. METHODS A comparative, descriptive design was used. Numeric rating scales were used to measure pain intensity and procedural distress; word lists, to measure pain quality. RESULTS Data were obtained from 6201 patients: 176 younger than 18 years and 5957 adults. Mean pain intensity scores for turning and tracheal suctioning were 2.80 and 3.00, respectively (scale, 0-5), for 4- to 7-year-olds and 52.0 and 28.1 (scale, 0-100) for 8- to 12-year-olds. For adolescents, mean pain intensity scores for wound dressing change, turning, tracheal suctioning, and wound drain removal were 5 to 7 (scale, 0-10); mean procedural distress scores were 4.83 to 6.00 (scale, 0-10). In adults, mean pain intensity scores for all procedures were 2.65 to 4.93 (scale, 0-10); mean procedural distress scores were 1.89 to 3.47 (scale, 0-10). The most painful and distressing procedures were turning for adults and wound care for adolescents. Procedural pain was often described as sharp, stinging, stabbing, shooting, and awful. Less than 20% of patients received opiates before procedures. CONCLUSIONS Procedural pain varies considerably and is procedure specific. Because procedures are performed so often, more individualized attention to preparation for and control of procedural pain is warranted.

Stressed Ge:Ga is currently the most suitable detector type for very low background operation in the 115 to 200 mu m range. Nonetheless, substantial advances have been required to develop stressed Ge:Ga detectors that work at the background limit in SIRTF. Both dark current and read noise have been improved significantly for the SIRTF devices. The design also takes account of space flight requirements such as the necessity to anneal the focal plane thermally using a minimum of cryogenic power dissipation, and the desire that any failures not propagate through an entire focal plane. The SIRTF 2x20 pixel focal plane will have dark current of about 200 e/s, read noise of 100 e rms, and responsivity > 7 A/W. As a result, even in the darkest parts of the sky, it will reach the background limit in less than 4 seconds of integration.

We describe the design, construction, and performance of the 32x32 Ge:Ga imaging array being built at the University of Arizona for the Multiband Imaging Photometer for SIRTF (MIPS). The array will support a number of operational modes in the MIPS instrument including natural background-limited mapping at 70 mu m, super-resolution observations at 70 mu m. and spectral energy distribution measurements between 50 and 100 mu m. The array is constructed in a modular manner using eight 4x32 pixel building blocks. To meet the sensitivity and stability requirements, the array must have excellent photometric repeatability, low noise, and robustness to the effects of the ionizing radiation environment in space. Key elements in attaining this level of performance are the Ge:Ga detectors materials and the cryogenic CRC-696 readout electronics. We present laboratory data for a 16x32 prototype of the array, and describe the plans for the construction of the qualification and flight units.

The Multiband Imaging Photometer for SIRTF (MIPS) provides the space IR telescope facility (SIRTF) with imaging, photometry, and total power measurement capability in broad spectral bands centered at 24, 70, and 160 micrometers , and with low resolution spectroscopy between 50 and 95 micrometers . The optical train directs the light from three zones in the telescope focal plane to three detector arrays: 128 by 128 Si:As BIB, 32 by 32 Ge:Ga, and 2 by 20 stressed Ge:Ga. A single axis scan mirror is placed at a pupil to allows rapid motion of the field of view as required to modulate above the 1/f noise in the germanium detectors. The scan mirror also directs the light into the different optical paths of the instrument and makes possible an efficient mapping mode in which the telescope line of sight is scanned continuously while the scan mirror freezes the image motion on the detector arrays. The instrument is designed with pixel sizes that oversample the telescope Airy pattern to operate at the diffraction limit and, through image processing, to allow superresolution beyond the traditional Rayleigh criterion. The instrument performance and interface requirements, the design concept, and the mechanical, optical, thermal, electrical, software, and radiometric aspects of MIPS are discussed in this paper. Solutions are shown to the challenge of operating the instrument below 3K, with focal plane cooling requirements done to 1.5K. The optical concept allows the versatile operations described above with only a single mechanism and includes extensive self-test and on- board calibration capabilities. In addition, we discuss the approach to cryogenic end-to-end testing and calibration prior to delivery of the instrument for integration into SIRTF.

We present the design for the multiband imaging photometer for SIRTF (MIPS). MIPS is a versatile instrument that provides diffraction-limited imaging at 30 micrometers , 70 micrometers , and 160 micrometers . MIPS also provides low resolution (5%) spectroscopy in the 50 - 100 micrometers wavelength range to allow the determination of far-infrared spectral energy distributions. The 70 micrometers array can also be used in a special high resolution mode that supports image reconstruction techniques for improved angular resolution. The one cryogenic mechanism on MIPS is a scanning mirror based on a space-qualified design used on the Infrared Space Observatory. We describe modifications to the scan mechanism to optimize it for use at very long wavelengths.

We present initial test results for far-infrared arrays built at the University of Arizona using Ge:Ga photoconductors and low temperature readouts operating at a temperature of 2 K. We also present separate test results for the Hughes CRC-696 multiplexer used in this program. The two array configurations considered are a 1 X 32 based on an older heated readout concept and a new 4 X 32 module that takes advantage of the benefits of having a true cryogenic readout. Based on these results, performance meeting the SIRTF goal of background-limited imaging can be expected for the 32 X 32 array under construction.

An infrared, cryogenically-cooled, grating spectrometer has been designed for the existing Steward Observatory telescopes; it will also be compatible with the Large Binocular Telescope (2 × 8.4-m) and MMT Conversion (6.5-m). On the Steward 2.3-m and using a NICMOS3 array of 256 × 256 40µm HgCdTe detectors, the instrument projects each pixel to 1.2 arcsec and has a slit approximately 90 arcsec long. On one barrel of the Columbus Telescope, the pixels would project to 0.33 arcsec and the slit would be 25 arcsec long. With a slit of 2 pixels width, the available spectral resolutions will range from 670 to 19,000. The optics are achromatic from 1.4 to 5 microns, allowing use of a variety of array types. The spectrometer was relatively inexpensive (< $400K) and is compact (͂ 0.3m3). The high spectral resolution in such a compact instrument will be achieved through an echelle grating immersed in silicon. We report on unique design features that may be useful for other spectrometers and show some of the data obtained with this instrument on the 2.3-m telescope. A complete description is given in Williams etal. 1993.

An infrared, cryogenically-cooled, grating spectrometer has been designed for the Columbus Project (2 X 8.4-m telescopes) and MMT Conversion (6.5-m). On one barrel of the Columbus Telescope and using a NICMOS3 array of 256 X 256 40 micrometers HgCdTe detectors, the instrument will project each pixel to 0.33 arcsec. With a slit of 0.66 arcsec width (2 pixels), the available spectral resolutions will range from (lambda) /(Delta) (lambda) equals 670 to 19,000. The optics are achromatic from 1.4 to 5 micrometers , allowing use of a variety of array types. The first version of this instrument has been built and fitted with optics that allow its use with the Steward Observatory 1.5-m and 2.3-m telescopes. It is relatively inexpensive (< $DOL400 K) and compact (approximately 0.3 m3). The high spectral resolution in such a compact instrument will be achieved through an echelle grating immersed in silicon. We discuss the processing for producing such gratings, including demonstrations that we have conducted on test blanks. We report on the preliminary performance of the prototype instrument and on unique design features that may be useful for other spectrometers.

Several cameras employing NICMOS2 (128 X 128) and NICMOS3 (256 X 256) arrays have been used in diverse applications on ground-based telescopes. Such use of arrays provides many insights to their performance that are not usually obtained in laboratory tests, and provides a baseline of performance over repeated thermal cycles. Astronomical use of these arrays also involves extracting accurate photometric information and detection of sources in spite of high background levels. The NICMOS arrays have proven very capable as astronomical imagers.

A prototype front-end system—Cirt—which permits weighting, ranking and relevance feedback on a traditional IR system—Data—Star—is described and discussed. Cirt is based on an integrated theory of search term weighting, document ranking and modification of weights based on relevance feed back. Previous laboratory tests on various aspects of the theory have led to the need for further evaluation in an operational environment; the intention of Cirt is to make such evaluation possible. The operating environment is described and the de sign of the system is discussed, including the machine to machine host/front-end dialogue, the user interface and some aspects of the programming. A project currently under way to evaluate Cirt against traditional retrieval methods under oper ational conditions is described. The article concludes with a brief word on the future prospects for this type of retrieval.

The uptake of a membrane potential (Δψ) probe by strain D27 of Saccharomyces cerevisiae has been shown to have properties consistent with entry occurring by means of a non-mediated process rather than the thiamine transporter. Experiments in which the mitochondrial membrane was selectively depolarised indicated that the probe used partitioned into mitochondria thus limiting its usefulness for quantitative measurements of Δψ across the cytoplasmic membrane.

Interaural time just-noticeable-difference (jnd) of a narrow-band noise masked by a wideband noise was measured for nine different interaural configurations of the masking noise at a fixed signal-to-noise ratio. The narrow-band noise was 1/3 octave wide centered about 500 Hz, and the wideband masker was bandpass filtered between 250 and 1500 Hz. Our results are in agreement with earlier results with tones [M. F. Cohen, J. Acoust. Soc. Am. Suppl. 1 64, S35 (1978); J. Acoust. Soc. Am. 70, 1289-1293 (1981); J. E. Slocum and R. M. Stern, J. Acoust. Soc. Am. Suppl. 1 68, S60 (1980)] and are the opposite of what may be expected from the results of binaural detection experiments: the jnd is largest for the interaurally phase reversed masker and smallest for the diotic masker. In addition, no consistent relation was observed between the size of the jnd and the perceptual location of the masker. Predicted jnds were calculated from a model based on the interaural phase difference of the stimuli in the two ears and were in rough agreement with the experimental results.

This paper reviews past studies of binaural interaction in impaired listeners. The topics covered include localization and lateralization; equal loudness, centering and lateralization adaptation; detection of signals in noise; and discrimination of interaural time delay and interaural amplitude ratio. Comments concerning experimental design and procedures, as well as interpretation of results, are often included with descriptions of the studies.

Monaural and binaural capabilities of a thirty-year-old male with a unilateral vestibular schwannoma were studied. His right ear appeared to be within normal limits for all tests. The threshold in his left ear was elevated approximately 20 dB from 250 to 1400 Hz and fluctuated sharply above 1400 Hz. Stimuli were pure tones and one-third-octave noise bands at three frequencies: 0.5, 1, and 3.3 kHz. Alternate-binaural-loudness matches showed decruitment. Frequency discrimination and frequency selectivity were reduced in the impaired ear, as indicated by large difference limens and broad tips of the psychoacoustical tuning curves. Intensity discrimination in the impaired ear was impoverished at all levels and frequencies except near threshold at 1 kHz. Experiments on interaural discrimination failed to demonstrate any sensitivity. For interaural amplitude, all above-chance performance could be attributed to monaural cues in the normal ear. For interaural time and interaural correlation, no sensitivity could be demonstrated. [Work supported by NIH.]

The just-noticeable difference (jnd) in interaural time delay for a narrow-band noise signal has been measured for ten interaural conditions of wide-band masking noise. The narrow-band signal is a one third-octave noise band at 500 Hz. The masking noise covers 250–1500 Hz. Both signal and masker have an overall level of 56 dB SPL. The masked jnds for narrow-band noise are consistent with those for tones [M. F. Cohen, J. Acoust. Soc. Am. 64, S35(A) (1978)] in that the progression of increasing difficulty (increasing jnds) is interaurally identical musket (NO), uncorrelated masker (NU), and antiphasic masker (Nπ). Note that this progression is exactly opposite to that expected from detectability results. Other interaural conditions of the masker include an interaural delay of τ = 100 μs (Nτ), an interaural attenuation of α dB (Nα), or both (Nτ,α), where α is realized by attenuating one ear and is chosen for each subject to center the masker when both τ and α are present. The jnds with these maskers show that the Nτ,α case is more difficult than Nτ or Nα. [Work supported by NIH.]