Children's categorisation of play and learning based on social context

While much time has been spent deliberating about the definition of play, little emphasis has been placed on what children themselves perceive as play. The aim of the present study was to examine social context as a cue for children's perceptions of play and learning. Ninety-two children aged between four and six years (mean four years nine months) participated in the study and completed the Activity Apperception Story Procedure. Children were asked to sort photographic stimuli into those they believed depicted play/not play and learning/not learning. Each of the stimuli were identified by independent raters as containing one of the following social cues; teacher absence (solitary activity, parallel activity or cooperative activity) or teacher presence (teacher involved activity or teacher directed activity). Findings revealed that children associated teacher absence with play. More specifically, children made links between play and the presence of peers (parallel and cooperative activity). Findings are discussed in relation to play in the early years curriculum, differences in children's early educational experiences and the importance of understanding children's perceptions of play.     

Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients

Introduction

Daily interruption of sedation (DIS) and sedation algorithms (SAs) have been shown to decrease mechanical ventilation (MV) duration. We conducted a randomized study comparing these strategies.

Methods

Mechanically ventilated adults 18 years old or older in the medical intensive care unit (ICU) were randomly assigned to DIS or SA. Exclusion criteria were severe neurocognitive dysfunction, administration of neuromuscular blockers, and tracheostomy. Study endpoints were total MV duration and 28-day ventilator-free survival.

Results

The study was terminated prematurely after 74 patients were enrolled (DIS 36 and SA 38). The two groups had similar age, gender, racial distribution, Acute Physiology and Chronic Health Evaluation II score, and reason for MV. The Data Safety Monitoring Board convened after DIS patients were found to have higher hospital mortality; however, no causal connection between DIS and increased mortality was identified. Interim analysis demonstrated a significant difference in primary endpoint, and study termination was recommended. The DIS group had longer total duration of MV (median 6.7 versus 3.9 days; P = 0.0003), slower improvement of Sequential Organ Failure Assessment over time (0.70 versus 0.23 units per day; P = 0.025), longer ICU length of stay (15 versus 8 days; P < 0.0001), and longer hospital length of stay (23 versus 12 days; P = 0.01).

Conclusion

In our cohort of patients, the use of SA was associated with reduced duration of MV and lengths of stay compared with DIS. Based on these results, DIS may not be appropriate in all mechanically ventilated patients.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00205517","term_id":"NCT00205517"}}NCT00205517.     

Surgical management of heparin-associated thrombocytopenia. Strategies in the treatment of venous and arterial thromboembolism

We report the vascular surgical strategies and results in 13 patients with heparin-associated thrombocytopenia and describe useful in vitro techniques for the evaluation of anticoagulant therapy. Thirteen of 40 patients with heparin-associated thrombocytopenia had 18 cardiovascular procedures done to save life or limb. Greenfield filters were placed in eight patients to prevent pulmonary embolism. Eight patients had 10 arterial procedures, with alternative anticoagulation that used dextran or warfarin in five cases. In three cases iloprost, a derivative of prostacyclin and a potent platelet inhibitor, was infused intraoperatively and heparin was given. Both the use of alternative anticoagulants and platelet suppression by iloprost were clinically effective strategies. The concurrent measurement of plasma levels of beta-thromboglobulin and fibrinopeptide A in two patients confirmed that both approaches can successfully prevent activation of platelets and plasma coagulation during arterial surgery. One operative death occurred; all vascular reconstructions remained patent at 3 to 6 months. In two patients who received heparin alone for arterial surgery, both procedures resulted in thrombosis and limb loss. When major venous thromboembolism is complicated by heparin-associated thrombocytopenia, insertion of a Greenfield vena cava filter should be considered if there is significant risk of pulmonary embolism. When necessary, arterial surgery is feasible in patients with heparin-associated thrombocytopenia if alternative anticoagulation or adequate suppression of platelet reactivity can be achieved.     

Criteria used by adults and children to categorize subtypes of play

Play subtypes of Activity and Pretend have been proposed yet no empirical study has determined the criteria that identify and differentiate these two play subtypes. Children (n=98) and adults (n=38) were shown 10 video examples of human and other primate. Activity and Pretend play and asked to identify which of six criteria (positive affect, non-literality, communication/intimacy, practice, physical context and social context) best characterized play. Results showed a significant difference between criteria used by participants to categorize Activity and Pretend play. Specifically, among all participants Pretend play was categorized according to behavioural (non-literality), motivational (communication/intimacy) and contextual (both social and physical) criteria. On the other hand, no one criterion was associated significantly more with Activity than Pretend play. No differences were found between adult and child participants in play criteria used to categorize each play subtype. A multidimensional definition of Pretend play is proposed and research into the definitional qualities of Activity play is recommended.     

Temperament and social behaviour at home and school among typically developing children and children with an intellectually disability

Background There has been limited research on differences in temperament between typically developing children and children with an intellectual disability (ID). Individual differences have generally been neglected in previous investigations of children with an ID. The present research investigated differences in temperament and social behaviour between typically developing children and children with an ID, in both home and school settings. Methods Participants were 100 children (M = 10.7 years, SD = 0.88) from both regular and special education schools. Temperament was measured using the Emotionality, Activity, Sociability (EAS) Temperament Survey for Children (parental and teacher ratings), while social behaviour was measured using the School Social Behaviour Scales, Second Edition (SSBS‐2) and the Home and Community Social Behaviour Scales (HCSBS). Results There were minimal significant differences in temperament between the regular and special education groups. Children who attended regular schools had a significantly higher level of social competence and significantly lower level of antisocial behaviour both at home and school, when compared with children who attended special schools. Conclusions The difference in social behaviour between children attending regular and special schools was attributed to the difference in intellectual ability of the two groups, as well as contextual influences of regular or special school environments.     

Strategies in the treatment of major tissue loss and gangrene: Results of 100 consecutive vascular reconstructions

To determine the features of a successful clinical strategy, we analyzed the results of 100 consecutive lower extremity vascular reconstructions performedexclusively for tissue loss and gangrene of the legs and feet. Eighty patients underwent 100 procedures on 80 limbs. Follow-up was 95% complete (every six months, mean 2.2 years). Forty inflow procedures to the femoral artery were performed with 13 simultaneous infrainguinal bypasses. Sixty bypasses were performed from the femoral artery to the popliteal (25) or tibial arteries (35). Sixty-eight percent of the identified ulcerations healed, and limb salvage was achieved in 70% of patients by life-table analysis. The cumulative patency for all reconstructions was 48% (five years), for tibial bypasses 60% (four years). Femoropoliteal bypasses had the poorest patency and healing rates (<40%), while combined inflow-outflow procedures and femorotibial bypasses had the highest rates of healing (77%, 66%). There were two operative deaths, three graft infections, seven wound infections, and 12 acute graft thromboses. Vascular reconstructions for extensive tissue loss or gangrene can be performed with a morbidity and mortality comparable to procedures performed for less severe disease with a high rate of limb salvage. The long term success of surgical therapy depends primarily on the most direct revascularization of ischemic, infected tissues, using autologous conduits whenever possible. Presented at the Annual Meeting of the Peripheral Vascular Surgery Society, New York, New York, June 17, 1989.