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Our objective was to examine the performance characteristics of a bladder stimulation technique for urine collection among infants presenting to the emergency department (ED).
This prospective cohort study enrolled a convenience sample of infants aged ≤ 90 days requiring urine testing in the ED. Infants were excluded if critically ill, moderately to severely dehydrated, or having significant feeding issues. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. The primary outcome was successful midstream urine collection within 5 minutes of stimulation. Secondary outcomes included sample contamination, bladder stimulation time for successful urine collection, and perceived patient distress on a 100-mm visual analog scale (VAS).
We enrolled 151 infants and included 147 in the analysis. Median age was 53 days (interquartile range [IQR] 27–68 days). Midstream urine sample collection using bladder stimulation was successful in 78 infants (53.1%; 95% confidence interval [CI] 45–60.9). Thirty-nine samples (50%) were contaminated. Most contaminated samples (n = 31; 79.5%) were reported as “no significant growth” or “growth of 3 or more organisms”. Median bladder stimulation time required for midstream urine collection was 45 seconds (IQR 20–120 seconds). Mean VAS for infant distress was 22 mm (standard deviation 23 mm).
The success rate of this bladder stimulation technique was lower than previously reported. The contamination rate was high, however most contaminated specimens were easily identified and had no clinical impact.
Introduction: A novel bladder stimulation technique has been described for midstream urine (MSU) collection in well-feeding, inpatient newborns. We sought to determine the performance of this technique amongst infants presenting to the Emergency Department (ED). Methods: Our prospective ED-based study enrolled a convenience cohort of infants aged ≤ 90 days who required urine testing. Infants with significant feeding issues, moderate to severe dehydration, or critical illness were excluded. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. Healthcare providers received standardized training in the technique. Primary outcome was the proportion of infants with successful MSU collection via the technique. Success was defined as adequate sample collection (≥ 1 mL urine) within 5 minutes of initiating stimulation. Secondary outcomes included the proportion of contaminated MSU samples, time required for MSU collection and full protocol completion, and patient discomfort as perceived by parent/guardian using a 100 mm visual analog scale [VAS]. Assuming success a priori in 50% of infants, a sample size of 115 allowed a 95% confidence interval of +/- 9.1% around the point estimate. Results: We enrolled 115 infants. Mean age was 53.0 days old (interquartile range [IQR] 26.7-68.0); 58.3% were male (69.2% uncircumcised). Midstream urine was successfully collected in 61 infants (53.0%; 95% CI 0.44,0.62). Thirty-one MSU samples (50.8%) were contaminated; uncircumcised males held the highest proportion (55.0%). Most contaminated samples (83.9%) were reported as “non-significant growth” or “growth of ≥ 3 organisms” and were easily identifiable as contaminants with minimal impact on clinical care. Only 4 (8.5%) of the 47 patients discharged home after successful MSU collection had a repeat ED visit for urine testing. Median stimulation time for MSU collection was 45 seconds (IQR 20-99 secs). Median time for full protocol completion was 30.83 minutes (IQR 24.42-46.83 mins). Mean VAS for infant discomfort was 20.2 mm (SD +/- 20.4 mm). Conclusion: Our pragmatic, ED-based study found the success rate of this bladder stimulation technique to be significantly lower (53%) than its published rate (86%). The contamination rate was high but most contaminated specimens were easily identifiable as such and had minimal clinical impact.
The paper is an investigation into the withdrawal rates of seven Scottish Offices and covers the years 1972-76 with an appendix giving the results for 1977.
The rates were basically analysed by class and duration with further investigations mainly on the 1976 data by age at entry, sex, size of sum assured, premium paying term, premium payment frequency and by type of agent introducing the business. Comparisons were made of the level of withdrawal rates among the various Offices and also the variations from year to year separately. A graduation of the combined data for 1975 and 1976 for each of the five main classes was carried out.
A. C. Crombie, University Lecturer in the History of Science, University of Oxford, and Fellow of Trinity College,
M. A. Hoskin, University Lecturer in the History of Science, University of Cambridge, and Fellow of Churchill College
Nearly all Galileo Galilei's (1564-1642) intellectual contemporaries would have agreed with his dramatic declaration that in order to introduce a new philosophy ‘it will be first necessary to new-mold the brains of men, and make them apt to distinguish truth from falsehood’. They called for a revolution in thinking about nature that would still be far in advance of results at the mid-century, but no previous generation had had so much reason to believe that it had at last acquired a method which, by correcting its own errors, offered the certainty of discovering the one actual structure of the physical world. Older habits of erudition and speculation in natural philosophy were losing their appeal and were being replaced by the practice of systematic research. The promise and achievements of the enterprise gave fresh confidence to appeals for conditions making such research possible, for more adequate provision for natural science in the universities and in new institutions, and for money to be spent on science in the public interest.
To a large extent the new science was establishing itself on the margins of official learning and recognized professional activities. This is reflected in the diversity of the occupations and social origins of the men engaged in science and the conditions in which they carried out their scientific work. Central to the traditional profession of learning were those holding academic posts in the faculties of arts or of medicine in universities or in newer institutions such as the Collège de France in Paris and Gresham College in London. If we include the minor figures this remained the largest single group. Yet the list of scientists who had no full-time academic post is equally impressive.
The years following publication of the Principia Mathematica in 1687 saw a gradual but definite change in the character and spirit of the European scientific movement. Newton's masterpiece showed for a fact that the ‘new philosophy’ could solve the most imposing of problems. No longer was it necessary, as in the heroic days of Bacon, Galileo and Descartes, to convince contemporaries by argument of the power of experimental and mathematical science. Scientific deeds had spoken for themselves. At the same time the Principia brought to a conclusion the great cosmological debate opened by Copernicus, and established mechanics as a model for all the sciences. With these developments, a period of adventure in ideas and organization gave way to one of systematization, fact-collecting and the diffusion of scientific ideas. Science became for a time distinctly less original. In 1698, Gottfried Wilhelm Leibniz (1646–1716) and the aged John Wallis (1616–1703), discussing in the Philosophical Transactions of the Royal Society ‘the cause of the present languid state of Philosophy’, found that among their younger contemporaries ‘Nature nowadays has not so many diligent Observers’. Two years later the Council of the Royal Society regretfully recorded that neglect and opposition had thwarted their plan to produce a series of useful inventions. Yet at this very time the influence of science was spreading as never before. A new profession had grown up. Scientific societies of high technical standards were soon to multiply, governments investing in science with the expectation of a profitable return. An expanding scientific journalism was spreading a new philosophy among a wide lay public.
By an ancient and honourable tradition, which began last year when I spared you this exercise, the President gives a Presidential Address only once during his term of office, on retirement. A presidential address in the summer season is a privileged occasion. Coming at the end of an active day, it is not the moment for a massive account of research. Rather it is an occasion when one may indulge with privilege in some directed impressionism, and that is what I propose to do.