The present study involved 105 German students at the end of their first semester in elementary school in order to explore the stress that students may experience within the school environment, and how the relationship with the teacher buffers or exacerbates the stress. Student-teacher relationships were explored on both classroom and individual interaction levels. Classrooms were described by external observers in terms of teachers' support and classroom organization. Teachers reported on the relationships with their students regarding closeness, conflict, and dependency, which determined four specific patterns of student-teacher relationships. Furthermore, saliva samples were taken on a Monday and a Friday of the same week (four times each day) to display diurnal cortisol profiles. These profiles were later evaluated by means of slopes and intercepts, reflecting students' daily stress regulation. Comparisons between Monday and Friday profiles of the same student served as an estimate for the stress regulation throughout the week. Finally, associations between the profiles and the specific relationship patterns provided information on significant environmental conditions for students' stress. Students in non-supportive, as compared to supportive, classrooms had flatter cortisol profiles, suggesting that classrooms of low quality hindered sufficient down-regulation of cortisol levels at both the beginning and the end of the week. Moreover, students with conflict-loaded relationships with their teachers were less able to appropriately down-regulate stress (especially on Fridays) than students with proximal-balanced relationships, showing the most optimal cortisol profiles.

OBJECTIVE: To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs. METHODS:The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. RESULTS:Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P , .001; nurses: 17% vs 55%; P , .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation.CONCLUSIONS: Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes. Pediatrics 2013;132:e211-e218 AUTHORS:

No abstract

No abstract

Abstract. We present a probit latent state model for dichotomous items with one latent state variable for each occasion of measurement and one latent item-effect variable for each item, except for a reference item. All latent variables are well defined in terms of conditional probabilities. The model offers the possibility to include explanatory variables for the latent states as well as for the latent item-effect variables. We illustrate the model by a data example with the life satisfaction scale of the Freiburg Personality Inventory (FPI-R; Fahrenberg, Hampel, & Selg, 1984 ) assessed at three time points. Allowing for item-effect variables improves model fit considerably and enhances our knowledge about the items. In some applications, this model opens new ways to investigate differential item functioning, and in others it allows to study response styles.