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Expert's Rating
- Slick interface
- Ability to create custom music collections
- Expensive
- Plays audio only
Our Verdict
AlbumPlayer keeps its attention focused on music organization and play back, and handles those tasks with ease.
AlbumPlayer is not trying to be everything to everyone. Instead, this audio software focuses its attention solely on music playback, on being jukebox software for music aficionados, and it succeeds. Its tabs let you switch between viewing all of your music, to sorting by artist, genre, composer, moods, and more. You also can create custom collections of your favorite tunes for easier access, though I found it unfortunate that you had to do so in a separate menu, rather than right in AlbumPlayer's main window. AlbumPlayer costs 30 Euros ($39 on 2/26/13) and has a free, playtime-limited demo. The first time you run AlbumPlayer, it asks you about your input device. AlbumPlayer is designed to work with touch screen controls as well as the more standard mouse and keyboard combination. After you make your choice, the software loads, and you'll see that it includes a few music samples. The developer says he put these samples (which are very small snippets of tunes) in there so you can see how AlbumPlayer will look when content is loaded. To add your own content, you have to point AlbumPlayer in the direction of your music collection. It located and added tunes quickly, but it balked at adding much of the content from my iTunes library before I downloaded and installed a dll that it suggested. (AlbumPlayer says that this step is necessary because of licensing restrictions.)
Once your music is added, you can use AlbumPlayer's slick controls to browse your collection. AlbumPlayer will allow you to rip CDs, but not burn them, nor will it sync with any portable devices (although you can copy music to a memory card). This is not an oversight, the developer says: AlbumPlayer is designed solely as a music organization and playback tool. And in that it succeeds: its slick interface lets you search through album covers, almost as if you were using a real jukebox. I tested AlbumPlayer using a mouse and keyboard and was impressed by the experience; I imagine it would be even more impressive using a touch screen. AlbumPlayer would make an excellent addition to a party, as you could create custom collections of music and allow party guests to do the same. It includes a Party Mode, which allows guests to select songs and create playlists, but uses a password to prevent them from editing your actual music collection or messing with the contents of your PC. Another cool party trick: if you have an iOS or Android device, you can take advantage of the TunesRemote version of AlbumPlayer. It's a 15 Euro upgrade over the Personal License, though you can purchase them as a package for 39.50 Euros ($52.89 as of 2/10). That's pricey for a music player, but it does give you the cool option of controlling the jukebox software remotely, from your mobile device.
Still, the bottom line is this: even the most basic version of AlbumPlayer is quite expensive at 30 Euros, which is close to $40. The demo is limited to 15 minutes of continuous play. And if you'd like to use it in a commercial setting, such as a restaurant, you'll have to pay 53 Euros for the commercial license. With that price—and its limited feature set—AlbumPlayer isn't for everyone. Note:The Download button on the Product Information page will download the software to your system.


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"Crickets" Can Be Destroyed through Spirituality
My dear young women friends, tonight I want to be sensitive to your feelings. I pray that you will open your hearts and that the Spirit will teach you as I speak to you about some things that are very important, that need to be talked about at this time. I love you. I have great faith in you. President Benson has taught that "you have been born at this time for a sacred and glorious purpose. … Your birth at this particular time was foreordained in the eternities." (Ensign, Nov. 1986, p. 81.) Even so, we have feelings of great anxiety for your welfare.
This is a glorious time to live, to be young, to face an exciting future; but it is also a very threatening and frightening time, if you are not prepared. And if you are prepared, there is no need to fear. (See D&C 38:30.) You are the pioneers of today and will blaze a trail into a wilderness unlike and perhaps even more challenging than that of the pioneers of earlier days. Your courage must be equal to, if not greater than, the courage of young women like Mary Goble Pay. From her journal we read: "We arrived in Salt Lake City nine o'clock at night the 11th of December 1856. Three out of four that were living were frozen. My mother was dead in the wagon. …
"Early next morning Bro. Brigham Young … came. … When he saw our condition—our feet frozen and our mother dead—tears rolled down his cheeks.
"The doctor amputated my toes. … The sisters were dressing Mother for [her grave. When my feet were fixed, they carried us in to see our mother for the last time.] That afternoon she was buried. …
"I [have] thought of [my mother's] words [before we left England], 'Polly, I want to go to Zion while my children are small, so they can be raised in the Gospel of Christ. For I know this is the true Church.'" (In A Believing People, Richard H. Cracroft and Neal E. Lambert, comp., Provo, Utah: Brigham Young University Press, 1979, pp. 107, 111.)
Do mothers today care that much for the gospel and for their children? They do; of course they do. Mothers, it may seem easier for you to die in the wagon than to stand guard every day in defending and upholding standards of righteousness. It may seem easier to die for the gospel in an effort to save your children than to live for it. But live it you must, so that they will not die spiritually.
And young women, it may seem easier for you to have your toes amputated than to be a pioneer today and stand on your feet in front of your peers and dare to be different if their actions violate what the Holy Spirit whispers to you is right.
We are warned in the scriptures, "Yea, and all that will live godly in Christ Jesus shall suffer persecution." (2 Tim. 3:12.) Peer pressure is a form of persecution. Peer pressure is one of the great tests of today.
Do you remember the story of the early pioneers and how the terrible plague of black crickets came down from the mountains to destroy the crops of grain? Men, women, and children prayed and fought those ravaging crickets in a desperate effort to save their crops. The Lord heard their earnest prayers and sent sea gulls. They devoured the crickets. The crops were saved. It was a miracle, they said.
Young women, you are the tender crops of today, the promise of tomorrow. President Gordon B. Hinckley has taught us that when we save one young woman, we save generations. Every young woman counts so very, very much.
In all soberness I ask you young women, mothers, leaders—all women—to consider the black crickets of our day that are trying to destroy our tender crops, not only our young women and young men, but many adults, also. We have been warned by our prophet that the "forces of evil increase under Lucifer's leadership and the forces of good increase under the leadership of Jesus Christ." (Ezra Taft Benson, Ensign, Nov. 1988, p. 87.) The heat of that great confrontation is becoming more intense. Sooner or later, either privately or publicly, we will all be tested. We must be prepared to defend our values, our standards, our commitments, and our covenants to stand as a witness of God at all times, in all things, and in all places.
The crickets of our day are different than in times past. They are powerful, more dangerous and less noticeable. Let me explain. At first, things may appear to be very innocent. Thoughts, words, and pictures are placed into our minds through very subtle and sophisticated ways. Thoughts come first and are then expressed through words. No one uses vulgar, crude words without first having the same kind of thoughts. Can you see how damaging such innocent beginnings are? If we are not watchful, the crickets will creep into our safe places, our homes, our hearts, and our minds. Through TV, radio, magazines, movies, literature, music, and fashions, these evil influences will aggressively begin their silent destruction, multiplying their forces as they go.
Television and video programs portray immorality as an exciting and acceptable act of love. Exposure to these messages of deception will dull your senses until what appeared alarming to you at first becomes of little concern and even acceptable. If this happens, that falsehood is unmasked. Your dreams become nightmares, and your hopes, destroyed.
Music has a very powerful and wonderful influence in establishing feelings and moods that can lift and elevate your thoughts and your actions. But because it is so powerful, it is cleverly used by the adversary to stimulate your thoughts, feelings, and moods, to pollute and poison your mind and cause you to do things you would not otherwise consider doing.
You want to be well-groomed, to look nice, and to be attractive. But you must be alert to the aggressive advertising of immodest fashions. Often the desire and practice of wearing such fashions begins innocently and early. Some mothers dress their little girls in ways that unknowingly train their appetite for the immodest fashions of the world, and when they are teenagers, the pattern is set and it's so hard to change.
When the counsel of our prophet to avoid dating until sixteen is disregarded, I say that is crickets. Early dating gives Satan a foothold. Single dating at an early age is an invitation for the adversary to attack you while you are away from the safety of the group. Immoral conduct, alcohol, drug abuse, the addicting and degrading effect of pornography, Satan worship and other cult activities are all tools of the adversary carefully designed to enslave you and, ultimately, destroy you. The battle between good and evil is very real. We determine by the choices we make each day where we stand, what our values are, and whom we have chosen to follow.
Melinda, from Idaho, a young pioneer of our day, wrote about how hard it was for her to have the courage to leave her friends when they were seeing a movie that was popular but clearly against her standards. "Some may think, 'It's just a movie, what's the big deal?'" she said. "But it's the little things that turn into big things. It's not easy to do, but the Lord will help us," she insisted. And when she left, others followed her. That's pioneering.
Parents and leaders, I am convinced that most youth will respond when they see no faltering, wavering, or weakening on our part. Mothers, how you live will make so much difference in how your daughters live. Consider carefully your standards and practices because they will follow. How will our youth know which way to go if there is no standard that is clearly set and taught by precept and example?
I firmly believe that activities and practices, even traditions that do not adhere to gospel standards, can be changed. Young women, you can unite and use positive peer influence to help bring about needed change. There is great power to change when there is unity—in families, in wards and stakes, in neighborhoods and schools—especially when motivated by righteous principles. However, if unacceptable activities are not changed by these efforts, then choose not to participate in them. You can do that. I know you can.
The Lord sent sea gulls to help those early Saints. Sea gulls are not the answer for us today. But spirituality is. We live in a world where many voices and influences are attempting to deceive youth and adults. You might honestly wonder, "How can I know for sure? Some things that are so enticing seem so innocent at first."
There is a sure way to know. Just as the Lord sent the sea gulls to destroy the crickets, He has provided safety and protection for you and me. Spirituality allows us to have the Spirit of the Lord with us, and when we do, we will never be deceived. He promises us, "I will … be your light in the wilderness … if … [you] shall keep my commandments." (1 Ne. 17:13.) Now listen to this: When you were baptized and then confirmed a member of The Church of Jesus Christ of Latter-day Saints, you were given the gift of the Holy Ghost. The Holy Ghost will help you recognize good and evil, right and wrong, and will teach you and help you remember the lessons you learned even before your earth life. He will strengthen you, comfort you, and give you peace. But there is something important that you must never forget. To have the companionship of the Holy Ghost, you must be clean; and to be clean, you must keep the commandments of God.
Let me say it another way. When we keep the commandments, we are clean; and when we are clean in our thoughts, our words, and our actions, we can hear the whisperings of the Holy Ghost. In answer to your prayers, you will feel what is right and you will be able to discern between good and evil.
Every right choice can conquer a cricket. Rebelling against the laws and the standards that God has given to protect us would be like killing the sea gulls to preserve the crickets.
Standards of the Church have been given to us to protect us and to help us grow spiritually. When the pioneers ended a day's journey, each night they checked their wagons for any needed repairs. They united in prayer for continued guidance and protection and took a reading of both distance and direction to see how far they had traveled and make sure they were on the right trail. We would do well to follow the same pattern today. A good measurement to ask concerning every important decision is whether or not this decision will move you toward or away from making and keeping sacred covenants and preparing for the ordinances of the temple.
When you go home this evening and in the days to come, will you think seriously about what it means to be a pioneer today? Talk these things over with your family and friends. Make a firm commitment to be guided by the Spirit concerning what you will do and what you will not do. At nightfall review your actions prayerfully, asking Heavenly Father for strength for you to live righteously so that you will hear and feel the whisperings of the Holy Ghost guiding you. Pray for forgiveness in those areas where you have fallen short and ask for strength to do better. When you do this, Father in Heaven will hear your prayers, and you will feel added strength and will become a powerful influence for good—a real pioneer!
I encourage you to participate in experiences that are outlined in your Personal Progress book. They are not just to keep you busy, but to build you spiritually. They are not tasks to try your patience or your obedience; they are experiences that will help build your spirituality and your testimony. In your meetings, pray for each other and with each other. There is great power in prayer. Young women, we call upon you to increase your spirituality by living righteously. Raise your standards high, that others might follow. You are the promise of tomorrow, the hope of Israel. "Rise in might / With the sword of truth and right; / Sound the war-cry, 'Watch and pray!' / Vanquish ev'ry foe today." (Hymns, 1985, no. 259.) God bless you. In the name of Jesus Christ, amen.

subset: commoncrawl


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Christmas is coming early this year! Well I don't mean that it's actually being moved or anything like that, but I'm going to do a Christmas letter in November. I don't usually do 'holiday' letters. To me they are just too common, too predictable, and I usually shy away from being that routine. However, this time I'm making an exception. Why, you say? Well, I just heard a program on FOTF this week and someone hinted on the program that it's been attributed that Oprah rejected the Gospel message of her childhood because she could not respect, could not understand the characteristic that God is a jealous God. She understood the word jealous to be a term that is considered by all to be a negative characteristic. I can't blame her for that, we sure teach ourselves that message. Kind of one of those, 'I'm jealous and you had better not even look the other way or I'll blow my top kind of God'. Anyway, that caught my attention, and now somehow I've got to turn that into a Christmas letter in November for you. Here goes. But before we start I need you to slow down, relax, turn off television or the world, take a deep breath and then consider…..
Scripture is always a good way to do a Christmas letter: 'a virgin will conceive and bear a son, and shall call His name Immanuel', Isaiah 7:14. Christ's birth the center of our story. Hey, I'm already into Christmas. The literal Hebrew text there is stating 'with us God'! That's not to be interpreted as a greeting but a very firm, meaningful declaration. The Hebrew word for with is IM and the word for God is EL. Im-manu-el! Now what if that scripture's true! And what if Romans 8:35-39, 'who can separate us? Shall tribulation, or distress, or persecution, or famine, or nakedness or peril or sword…I am persuaded that neither death, nor life, nor angels, nor principalities, nor powers, not things present or things to come, nor height, nor depth, nor any other creature shall be able to separate us from the Love of God which is in Christ Jesus our Lord' were true? Have you ever really thought long about the fact that the Holy Spirit of God has come to comfort us, is present with us wherever we are, no matter what we are doing? 'With us God', (Immanuel) has a much 'weightier' meaning than we have given it credit for. God being with us was the Gospel plan all along, and it is something that carried the greatest importance for Him and for us. In the Old Testament, God was on the prophets, priests and kings. No one else experienced Him; they could only be told of Him by the three anointed positions of the Old System. That has changed and it has been changed because it was the will of God to change it. IM within this context is a heavy word. It's not like someone is just in the same room with you, not someone only occupying the adjoining space with you. It's not someone simply watching from across the room. In this word is a deep mingling of God and us. Jesus said that it was better that he went away and the Holy Spirit comes for us. Why? Simply, he could be in Jerusalem but not in Southern Illinois at the same time. That changed, it was better that Jesus, who was in contact with many, leave and ascend to the Father so that the Holy Spirit would come and could be in contact with all. All could be touched, not just those in Jerusalem! It was God's desire to be with us anywhere and everywhere! Unlike the Old System, where God was 'on them', in the economy of Grace and the Spirit of God, He is 'in them'.
Many years ago I had, for a very short time, too short a time actually, a double barreled shotgun. It was made of Damascus steel. That is very special steel. The way that original Damascus steel was forged has been lost, having been perfected in medieval times. Damascus steel was said to be the hardest steel created. It was used for ancient swords. It could hold an edge that was said to 'cut through a rifle barrel'. It was tough. Somehow, Damascus steel, being ancient, took the impurities found in the forging and changed them molecularly and created a sword resistant to shattering. This process of forging mingled the minerals until you could not tell where one starts and the other ends. Damascus steel is one in that sense, yet you can clearly see in the steel itself the obvious mingling of the forger with its waves of steel. It was a nice antique and I still kind of kick myself for getting rid of it.
That mingling of Damascus steel is a lot like what the word with ('im') means. All such Bible words translated into the English (such as dwell and abide) are related to 'im'. They are emotional, passionate words given with great feeling and hope. Remember Joseph, having been falsely accused and having been sold into slavery by his brothers, sitting in prison and telling his story at every turn, he remembered that 'God was with Joseph', mingled with his life, part of every moment. David also knew the joy of that. Read the 3rd, 23rd and 32nd Psalm for clues of how much David knew that God was with him. David wrote the 23rd Psalm while being chased by his own son whose purpose was to kill David– read that Psalm with that in mind! Obviously, it would take too long to express all the examples and all the passion of what 'with us God' means for us in this letter.
Now, what if He was with us at Walmart, the Civic Center, at work, at home, not just at church, but everywhere? Would that change your confidence? Would it make a difference knowing God was present with us all the time, in the good times and the hard times? Present in our celebrations and our mourning. Not just observing them but a part of actually going through them with us. Would that make a difference? Well, I believe He does just that.
That brings me back to Oprah. Apparently, she could not reconcile the thought of a jealous God, seeing that as a negative, angry, getting even kind of God. That's not what the ancient word means at all. Jealous is not defined in the typical English fashion found in our traditions. The true meaning of that original word is to identify a 'passionate, longing of love,' Godly Love, for the object of that Love. Our Jealous God is a God consistent with the Gospel Good News, who because of His passion to be 'with us' eagerly seeks us out. That with us is not just a shopping trip to the store and hope we find a bargain on the trip. It's a fire (fire like that forged steel sits in) that burns out of the coals of His Love for us, not a jealous God who is seeking His own way or His own purposes, but aggressively Loves us. He is jealous for us because He cares for us so much. In the original language, the world God so loved that he gave His only Son, that God is jealous, so much that His Love drove Him to Grace and Mercy for us. Made a way for us. Prepared a place for us. Sought us out. Became Sin for us. That's something we need to permit to happen in us. This Gospel is Good News but it's entirely up to us whether we accept and believe God Loved us that much that He did that much for us.
Now you have to be doing one of two things to come up with Oprah's kind of objection about God. You either are too lazy to search out the truth and the real answer, or you are silly enough to use it as an excuse to justify what you wanted all along, hoping to find some reason not to believe. I have never, after searching and seeking out the heart of God, been disappointed in that chase. He is always much more grand, much more loving than I had imagined. His name will be called Immanuel…with us God! Can you let that happen? Can you let that be true? Can you not doubt that? This Gospel is not about how God was with us in the past, not about Him being with us in the future. While both of those are true, we must come to believe that God is with us now. His presence invites us to leave those things that are behind and not speculate about the future, but be in His presence now. It's not a supernatural moment we need, it's the reality of He is in every moment, super or not. The question is not whether He is present, the question is are you!
'Glory to God in the highest, Peace, Good Will toward men.' (Luke 2:14) Christmas in November.


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Why Won't AdWords & YSM Send Me Traffic?August 9, 2009 Posted by Tyler Cruz
I've now been running my campaign on Yahoo Search Marketing for 2 weeks. I haven't tweaked or optimized anything yet though since I am not getting many clicks and need a lot more data before I can start fidgeting around.
After I got my first campaign up and running on YSM, I proceeded to work on the site for my second campaign. I finished it on August 5th and set up a new campaign for it on YSM. I kept checking to see if it had been approved and was getting traffic, but it seemed to be taking a while.
I kept checking, about once an hour or so, and after 5-6 hours it still hadn't been approved. It has now been 4 days and it's still sitting there, unapproved.
Slapped on YSM?
So what's going on here? I know that YSM takes a while to approve new campaigns, but 4 days seems like a long time.
Is this what people are referring to when they say they've been slapped? The thing is, all my ads are still showing as pending under editorial status, and it does not say disapproved anywhere in my campaign.
Slapped on AdWords?
After waiting for several days, I finally got tired and decided to port my campaigns over to AdWords. I transferred both my campaigns by hand, and it only took about 15-minutes for my first campaign to start receiving traffic!
But the second campaign, the same one that isn't running on YSM, is still yet to be approved, just like on YSM. It has been about 30 hours since I added it, so I'm curious what's going on.
And, just like on YSM, there is no indication of disapproval. It simply states that the status is under review:
I have not received a single impression on the campaign yet.
I am seeing a 5/10 Quality Score, and the interface confirms that it's now showing ads, but I'm not sure why it would take so long for this campaign to be approved. I added it right after I added the first campaign to AdWords, maybe 15-20 minutes afterwards.
Now, before you guys comment, this is NOT A REBILL. I purposely avoided rebills for this very reason. And my landing site is not a flog or anything shady like that. It's a legitimate 7-9 page site complete with a privacy policy and all that good stuff. And the offer is nothing questionable either.
The only thing I can see them having an issue with is if they are somehow being hypersensitive about the offer and are actually reviewing it, but seriously, the offers I'm running are probably among the most safest and legitimate offers available on a CPA network. They're cost-per-sale offers too.
Ideas, Anyone?
Does anyone have any idea what is (or could be) going on here? I'm really frustrated right now as I hate waiting and have no idea why it's taking so long to green-light my second campaign.
I'd really appreciate hearing your comments.
Meanwhile, I think I'm going to look for 2 new offers and start working on building sites for them. Hopefully at least one of them will be accepted as a new campaign. It sucks though, as I spent a lot of time working on the site for my second campaign, and since it was custom-built towards the particular offer, I can't use any of it for another site.
My Results So Far
I've been running YSM traffic to my first campaign for 2 weeks now, and my Google campaign just starting running yesterday. Here are the results so far:
As you can see, it started out pretty slow but picked up during the past 4 days where I profited each day. And yesterday I had a great day, netting nearly $75.
Now, the bad news is that this is most likely just a by-product of variance since I have made no changes to my campaign other than a couple of quick Ad Group pricing modifications.
Therefore, there's no reason why my campaign should be faring better now when it was really no different from August 1st-4th. However, it is possible that my QS has improved over time thus dropping my CPC costs and perhaps improving my ad position, but I really think this is just variance.
Once I get more data I will start to tweak the campaign more.
32 Responses to "Why Won't AdWords & YSM Send Me Traffic?"
My guess is you bought a domain that's been previously blacklisted with the search engines.
Although that's just a guess since that would probably put your QS down to 1, not 5.
Other possibility could be low quality score on your Google account in general? Perhaps some old campaigns you ran that were not very Google friendly.
These are just guesses.
Is there a number that you call to see why they are not approving your campaigns? Greg Ellison
I don't have advice on the pending ads, but -5% ROI sounds pretty good without any optimization. I'm looking forward to seeing how it improves as the campaigns mature.
from what i can see in one of your screen shots your under review. it will take a couple days for them to either approve your ads or either decline them.
btw if your running anything weightloss, grants, dating, etc etc those shady offers your probably banned. check your email that you signed up with adwords with. even if you pushed those products in the past you will be banned. even if it was just for 1 day. it happened to me and it happened to hundreds of other affiliates.
I wonder why it was taking so long. Do they put a hold on new domain names or anything?
it look like you don't make anything finally . i wonder what happened with them , but i hope they can give more better service to the customers
That is weird. I have only set up a few campaigns on adwords before, but never had a problem with anything.
Not sure why you're having issues, but I've never been able to run a successful campaign on AdWords so I can't really contribute too much :p
Interesting, looking forward to the follow up post
Are you running on the content network? That can sometimes cause major delays in getting things approved.
Jason is right. If you are running any kind of rebill, you might as well forget it.
Whats happened to your twitter account Tyler? your twitter pages says its been suspended and has been like that for a few days now?
Not quite sure why you are having trouble getting approved, but you might try contacting customer support via emai or by phone.
will be looking forward for the follow up post.
Thats wierd. I am getting ready to run yahoo ppc, and I always like to start my campaigns with yahoo because of the low overhead. If you have a grand to start a new yahoo account with you can get one of the account reps to do all your keyword research for you and then once they do that you can grab all those keywords and bring them on over to Googles Adwords ppc program.
Tyler, Hello! I love your blog, but it's worth to start a new banner campaign if you have a product! And all of your readers can start it too. Why?! You spend more than hundred dollars for a few days at your campaigns… And at this link you can buy a paradise place for your banner for $100 per YEAR! Yes, not week, or month, per Yeah! Hurry up!
will be looking forward for the follow up post.
well, just be patient. someday it'll work.
me too never had problems with adwords have been using from some time
I don't thin Adwords should give you such problems. But not sure about YSM as I didn't looked at it till now ever.
I think this is quite normal, is always necessary to wait for a few days ..
Google hates affiliates, and has been heavily reviewing/banning people promoting rebill products. IF you're promoting a rebill product that could explain why.
Was it some holiday in US..Maye the guys did not review it for that reason!
Hopefully it will start picking up.
I wonder why it was taking so long.i think its necessary to wait for a few days .looking forward to the follow up post
I have only set up a few campaigns on adwords before
Hello.This post was really motivating, especially because I was investigating for thoughts on this matter last Saturday.
Do you mind if I quote a few of your posts as long as I provide credit and sources back to your blog? My website is in the exact same area of interest as yours and my users would really benefit from a lot of the information you present here. Please let me know if this okay with you. Appreciate it!


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Mayo clinic researchers have found that shock wave lithotripsy, which is given for treating kidney stones have increased the risk of diabetes and also hypertension in later part of life. Risk for diabetes was related to the intensity of the treatment and quantity of the shock waves administered; hypertension was related to treatment of stones in both kidneys.
Shock wave lithotripsy uses shock waves to break up an impassable kidney stone into smaller, sandlike pieces which can be passed spontaneously, usually within a month. The patient and the lithotriptor that emits the shock waves are placed in a water bath. Water allows easier conduction of the shock waves through the patient's tissue and precise focus on the kidney stone.
"This is a completely new finding," says Amy Krambeck, M.D., Mayo Clinic urology resident and lead study investigator. "This opens the eyes of the world of urology to the fact that hypertension and diabetes are potential side effects. We can't say with 100 percent certainty that the shock wave treatment for the kidney stones caused diabetes and hypertension, but the association was very strong. The risk of developing diabetes after shock wave lithotripsy is almost four times the risk of people with kidney stones treated with medicine, and the risk of developing hypertension is one and one-half times, which is a significant risk increase."
The researchers hypothesize that the increase in risk for diabetes associated with shock wave therapy for kidney stones relates to damage inflicted to the pancreas, a previously known risk of lithotripsy, which may affect the islet cells in the pancreas that make insulin. They believe the increased risk for hypertension may relate to scarring, which the treatment may cause to the kidneys and could alter the secretion of hormones centered in the kidneys like renin, which influence blood pressure.
Drs. Krambeck and Joseph Segura, M.D., Mayo Clinic urologist and study investigator, say that they continue to use shock wave treatment, among other alternative treatments for kidney stones.
"Despite the risks, shock wave therapy still can save the day for patients, and it would be a mistake to put it on the shelf," says Dr. Segura.
The researchers indicate that they now counsel patients about the potential risk for diabetes and hypertension prior to shock wave treatment.
Dr. Segura stresses the need for kidney stone patients and their physicians to weigh the pros and cons of shock wave treatment according to individual situations. "It's a trade-off about whether the risks are worth taking," he says. "We're assuming doing nothing is not the right thing to do for patients. You have to look at it in terms of treatment alternatives -- percutaneous stone removal [removing a kidney stone through a small incision in the patient's back using an instrument called a nephroscope] or ureteroscopy [snaring a stone with a small instrument passed into the ureter through the bladder and then breaking up the stone with ultrasound or laser energy] -- each of which has its own set of risks."
The Mayo Clinic researchers examined the long-term effects of lithotripsy for patients treated with a 1985 lithotriptor, one of the early models, in this study. Drs. Krambeck and Segura say additional research studies, including research on newer machines and different models, are needed on shock wave therapy and risk for diabetes and hypertension later in life.
Prior to age 70, approximately 10 percent of men and 5 percent of women will experience a kidney stone, according to the National Institutes of Health. About 1 million people in the United States have had shock wave lithotripsy, says Dr. Segura.
Source: Newswise


text: A Seattle computer security consultant says he's developed a new way to exploit a recently disclosed bug in the SSL protocol, used to secure communications on the Internet. The attack, while difficult to execute, could give attackers a very powerful phishing attack.Frank Heidt, CEO of Leviathan Security Group, says his "generic" proof-of-concept code could be used to attack a variety of Web sites. While the attack is extremely difficult to pull off -- the hacker would first have to first pull off a man-in-the-middle attack, running code that compromises the victim's network -- it could have devastating consequences.The attack exploits the SSL (Secure Sockets Layer) Authentication Gap bug, first disclosed on Nov. 5. One of the SSL bug's discoverers, Marsh Ray at PhoneFactor, says he's seen a demonstration of Heidt's attack, and he's convinced it could work. "He did show it to me and it's the real deal," Ray said. The SSL Authentication flaw gives the attacker a way to change data being sent to the SSL server, but there's still no way to read the information coming back. Heidt sends data that causes the SSL server to return a redirect message that then sends the Web browser to another page. He then uses that redirect message to move the victim to an insecure connection where the Web pages can be rewritten by Heidt's computer before they are sent to the victim."Frank has shown a way to leverage this blind plain text injection attack into a complete compromise of the connection between the browser and the secure site," Ray said.A consortium of Internet companies has been working to fix the flaw since the PhoneFactor developers first uncovered it several months ago. Their work gained new urgency when the bug was inadvertently disclosed on a discussion list. Security experts have been debating the severity of this latest SSL flaw since it became public knowledge.Last week, IBM researcher Anil Kurmus showed how the flaw could be used to trick browsers into sending Twitter messages that contained user passwords. This latest attack shows that the flaw could be used to steal all sorts of sensitive information from secure Web sites, Heidt said. To be vulnerable, sites need to do something called client renegotiation under SSL and also to have some element on their secure Web pages that could generate a particular 302 redirect message.Many high-profile banking and e-commerce Web sites will not return this 302 redirect message in a way that can be exploited, but a "huge number" of sites could be attacked, Heidt said.With so many Web sites at risk to the flaw, Heidt says he does not intend to release his code immediately.From the victim's perspective, the only noticeable change during an attack is that the browser no longer looks as though it's connected to an SSL site. The attack is similar to the SSL Strip attack demonstrated by Moxie Marlinspike [cq] at a security conference earlier this year. Leviathan Security Group has created a tool that webmasters can use to see if their sites are vulnerable to a SSL Authentication Gap attack.Because SSL, and its replacement standard, TLS, are used in a wide range of Internet technologies the bug has far-reaching implications.Thierry Zoller, a security consultant with G-Sec, says that theoretically, the flaw could be used to attack mail servers. "An attacker can potentially highjack mails send over secured SMTP [Simple Mail Transfer Protocol] connections, even if they are authenticated by a private certificate," he said in an instant message interview. Zoller, who has not seen Leviathan's code, said that if the attack works as advertized, it will be just a matter of days before someone else figures out how to do it.


text:
Priscille Musabirema1
Petra Brysiewicz2
Jennifer Chipps3,4
Affiliations:1School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Nyarugenge Campus, Rwanda
2School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
3School of Nursing, University of the Western Cape, South Africa
4Sydney Nursing School, University of Sydney, Australia
Correspondence to:
Petra Brysiewicz
Postal address:
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
Received: 22 Mar. 2015
Accepted: 22 June 2015
Published: 03 Dec. 2015
How to cite this article:
Musabirema, P., Brysiewicz, P. & Chipps, J., 2015, 'Parents perceptions of stress in a neonatal intensive care unit in Rwanda', Curationis 38(2), Art. #1499, 8 pages. http://dx.doi.org/10.4102/curationis.v38i2.1499
Copyright Notice:
© 2015. The Authors. Licensee: AOSIS OpenJournals.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
Background: Having a newborn infant hospitalised in the neonatal intensive care unit (NICU) is an unexpected and stressful event for a family. A number of potential stressors to which family members of patients in these units may be exposed have been identified, although no studies about this issue have been conducted in Rwanda.
Aim: The aim of this study was to describe and analyse parental perception of stress that resulted from having their infant admitted to a NICU in Kigali, Rwanda.
Method: A quantitative survey was used to describe and analyse parents' perceptions of stress when they had an infant admitted to a NICU. The Parental Stress Scale: Neonatal Intensive Care Unit was used to measure the level of stress that those parents experienced.
Results: The results indicated that parents experienced stress from having their infants cared for in a NICU. The most stressful events were the appearance and behaviour of the baby with a mean score of 4.02, whilst the subscale items related to sights and sounds were found to be the least significant source of stress for parents with a mean score of 2.51. In addition, the current study found that parents' age, educational level, occupation, and infant birth weight were associated with parental stress.
Conclusion: The study established that a range of factors was responsible for parental stress when a baby was cared for in a NICU. Identification of these factors could enable health professionals from a hospital in Kigali, Rwanda, to facilitate parents' adjusting and coping.
A number of potential stressors to which family members of patients in a neonatal intensive care unit (NICU) may be exposed have been identified in the literature. The complexity of the physical environment of a NICU, the infant's physical appearance and behaviour, staff and parent interaction and adjustments in the parents' role have specifically been noted to be potentially stressful for parents with infants in a NICU (Trombini et al. 2008). In addition, the distress that these parents experience has been noted to influence their parenting behaviour (Lefkowitz, Baxt & Evans 2010) and can affect the long-term relationship with their children and their ability to take care of them (Carter et al. 2007).
In Rwanda there is only one hospital with a NICU where newborn babies with health problems are cared for. In the Rwandan culture, when a baby is born, everyone in the family is excited and ready to receive the newborn baby at home. The very first 'official' social function in the family to recognise the homecoming of the infant is the naming ceremony, commonly known as Kurya ubunnyano, which is held on the eighth day after the birth of a child (Nsanzimana 2012). In the event that the baby is admitted to a NICU, the routine ceremonies are not held and all family members may become demoralised and worried about the health of the infant.
A variety of factors, including personality, mental health, family, as well as social and pregnancy-related events are likely to contribute to the type and magnitude of stress that parents of an ill neonate experience. These factors have been noted to contribute to parental stress such as family functioning, socio-economic status, parent perceptions of infant illness, high trait anxiety, and available sources of support (Busse et al. 2013; Holditch-Davis & Miles 2000; Singer et al. 2010). Furthermore, the length of stay of the infant in a NICU is thought to have an effect on parental stress and it has been demonstrated that the longer the baby is hospitalised, the higher the level of stress, specifically for fathers, with regard to their communication with the staff (Harvey 2010). In Rwanda, the researcher's own experience indicates that parents with infants in a NICU are challenged by the policies and regulations in respect of family access to their babies and Hurst (2004) emphasises the need for parents to have access to their babies. Restricting visiting hours reduces the ability to assume the parental role and creates a separation between the infant and parents (Bruns & Klein 2005). It is recognised that poor staff-family interaction does not only influence the baby's care negatively, but may also be a source of distress and discontent for the parents (Orzalesi & Aite 2011).
Having a newborn infant hospitalised in a NICU is an unexpected and stressful event for the family (Busse et al. 2013). The NICU is a specialised area that provides medical treatment and nursing care either for infants born prematurely, or for seriously ill newborn infants. Under normal circumstances the process of parent-infant bonding occurs within the first few days after birth and creates the basis for a lifelong relationship between the parents and their offspring (Gooding et al. 2011). Parent-infant bonding can be affected when the baby is born prematurely or experiences health risk, which necessitates admission to a NICU. The admission of a newborn baby to a NICU in conjunction with other stressors of being in ICU could cause substantial stress for the parents. Reducing parental stress and anxiety during the infants' hospitalisation in a NICU should be a key nursing support function to enhance parental skills in challenging situations.
Although cross-cultural studies that investigate parental responses to their child's hospitalisation have been conducted (Krulik et al. 1999; Lau et al. 2007), parental perception of stress in a NICU in the Rwandan context lacks investigation.
The aim of this study was to describe and analyse parental perception of stress that resulted from having their infants admitted to a NICU in Kigali, Rwanda. The Parental Neonatal Intensive Care Unit Stress Model (Wereszczak, Miles & Holditch-Davis 1997) was the conceptual framework chosen to guide this study.
The objectives of the study were:
Stress: Stress is defined as 'psychological and physical strain or tension generated by physical, emotional, social, economic, or occupational circumstances, events, or experiences that are difficult to manage or endure' (Colman 2003:711). In this study, stress refers to psychological and physical strain or tension experienced by a parent whose infant has been admitted to a NICU as measured by the Parental stress scale: Neonatal intensive care unit (PSS: NICU).
Stressor: A stressor is defined as physical, psychological or social force that puts real or perceived demands on the body, emotions, mind, or spirit of an individual (Colman 2003). In this study, a representative list of potential stressors refers to NICU sights and sounds, the way the baby appears and behaves, an adjustment in the parental role, and interaction with staff.
Identifying the stressors parents experience could assist health professionals in a NICU with planning suitable interventions that are more family centred. In nursing practice, the findings of this study will assist with raising health professionals' awareness about parents' stressors in a NICU in Rwanda; it will also assist them with providing the relevant support to the parents who have a child in a NICU. At educational institutions, it will assist educators in emphasising possible gaps in the current nursing curriculum that need to be addressed.
Newborn babies born prematurely or the ones who experience medical complications are admitted to NICUs. Hall (2005) explains that being a parent of a newborn baby in a NICU is like being in another world; it is very different from what the parents have known and experienced before. Sights and sounds of the unit, infant appearance, parent-infant relationship and/or parental role and staff communication are emphasised as NICU environmental stressors (Wereszczak et al. 1997). The literature review describes the stressors that parents experience in this situation and the factors that contribute to the situation.
In a NICU, the baby is exposed to various forms of technology with disturbing sights and sounds. They are attached to many machines that measure heart rate and oxygen levels and these machines are beeping and buzzing around them. The environment in a NICU could, therefore, become very overwhelming to the baby, and also to the parents (Carter et al. 2007; Singer et al. 2010).
The physical appearance of the infant in a NICU and the perception that the baby is in pain may result in parental distress. The sights, sounds, and general environment of a NICU often cause stress and panic. Along with these issues, parents often experience difficulties with caregiving competencies and communication concerns related to the care of the infant. Furthermore, caregiving concerns frequently relate to parents' apprehension upon discharge of their infants from a NICU.
The feeling of disruption of the parental role also contributes greatly to the amount of stress of parents in a NICU (De Rouck & Leys 2009). Recent studies using the PSS: NICU are consistent in their findings that indicate the change in parental roles is an important aspect behind parental stress in NICU settings (Carter et al. 2007; Dudek-Shriber 2004; Lau et al. 2007; Preyde & Ardal 2003; Shaw, Ikuta & Fleisher 2006). Interaction between parents and their infants is regarded as a crucial activity that has a significant impact on the parental care of a child, therefore, it directly relates to parental roles in NICU settings. Shaw et al. (2006) explore the influence of psychological distress amongst parents of infants in a NICU and report a strong correlation between severe presentation of acute stress disorder and parental role alteration. Another source of stress for mothers documented by Phillips and Tooley (2005) is the distress they often feel when they do not see, touch, or are not in close proximity of their babies. Understanding possible factors associated with parental stress is a fundamental principle for providing quality care that responds to the parents' needs in such a way that it reduces stress and anxiety in a NICU.
A study conducted by Dudek-Shriber (2004) investigating factors related to altering parental roles experienced by parents in NICUs identifies that younger parents and parents of infants who suffer from a heart disease score the highest stress, related to change in parental roles. Several studies about parental stress that is the consequence of staff-parent communication in a NICU have been conducted (Browne & Talmi 2005; Nugent et al 2007). Browne and Talmi (2005) report that when parents are not provided with communication and information about the needs, care, and physical appearance of their infants, their stress levels increase. The same observation is revealed in the research study conducted by Harvey (2010) where ineffective staff communication is identified as a source of the highest level of parental stress.
Related to the parental stress factors in a NICU, language and cultural barriers are indicated to play a role in the amount of stress a family might experience whilst having an infant in the unit. Language barriers prevent families from accessing pertinent information about their infants (Denney et al. 2006). The study by Denney et al. (2006) regarding the levels of parent stress reveals that communication and linguistic barriers in a NICU environment yield high stress levels for parents. Underlining the importance of communication, the high demands placed on hospital professionals often result in a lack of time to communicate with the families (De Rouck & Leys 2009). Furthermore, the technological environment of the intensive care unit presents a challenge for the staff to facilitate a collaborative relationship with families whilst monitoring and caring for their critically ill infants (Johnson 2008).
Parental stress is in fact exacerbated by multiple factors such as personal characteristics of parents, situational factors, personal resources, and support in a NICU environment.
The personal characteristics of the parent, such as their past experiences and their personality, may influence parental stress. Literature in support of the link between parental stress and past experiences includes the developmental theory of continuity, whereby past experiences and an individual's adjustment to these experiences are thought to influence later psychological functioning (Obeidat, Bond & Callister 2009). Positive past experiences are thought to promote later healthy functioning. Conversely, unpleasant past experiences are thought to increase an individual's vulnerability to stress (Steedman 2007). Holditch-Davis and Miles (2000) similarly state that there are indications that past experience is a contributing factor to the level of stress experienced in a NICU.
When considering the quality or style of parenting displayed by an individual's parents, two parental qualities that have been consistently identified in the literature are care and overprotection (Parker, Barret & Hickie 1992; Parker, Tupling & Brown 1979; Steedman 2007). Care is defined as '... affection, emotional warmth, empathy, and closeness' (Parker et al. 1979:8) and overprotection control as '... intrusion, excessive contact, infantilisation [sic], and prevention of independent behaviour' (Parker et al. 1979:8). Care appears to be the stronger construct of the two, as it accounts for more of the variance in a factor analysis undertaken by Parker et al. (1979). Either care or overprotection in an individual's childhood is linked to the level of stress when such an individual becomes a parent (Assel et al. 2002; Carter et al. 2007). Assel et al. (2002) described the constructs of 'warm responsiveness' and 'restrictiveness' of parents, which correspond to care and over protection respectively. Structural equation modelling reveals significant pathways of influence. Mothers who have been exposed to the harsh and neglecting parenting qualities of their parents experience higher levels of stress and display lower levels of warmth towards their own children (Assel et al. 2002; Carter et al. 2007).
Other studies explain how personality may influence parental stress (Carter et al. 2007; Mulder et al. 2006). These studies conclude that personality dimensions are predictors of psychopathology, including neuroticism, anxiety, and depression.
Once an infant is admitted to a NICU, many factors account for parental stress. According to Denney et al. (2006), the birth of a newborn baby that results in the admission to a NICU is the initial stressor for a family. Parents fear for the survival of their infant and begin experiencing feelings of worry, depression, and anxiety (Obeidat et al. 2009). Similarly, the noticeable influence of the infant's condition on parental stress is also reported (Carter et al. 2007; Dudek-Shriber 2004). The medical condition of an infant and the required medical/surgical treatment might directly increase parental stress (Carter et al. 2007).
Families may be faced with prolonged periods of stress, anxiety, and may often experience depression during the course of their child's stay in a NICU. Indeed, the environment may affect parenting abilities, with adverse influences on the family unit, bonding, and the infant's long-term developmental outcomes. Adding to these difficulties, at the time a premature baby is admitted to a NICU, there is often uncertainty about the baby's prognosis. This is explained by the fact that the babies in a NICU are often in a critical condition. Parents are often very aware of the fact that these infants are at a higher risk of dying.
Wereszczak et al. (1997) explain personal resources of the parent as being family support, cognitive and financial resources. There is some indication in the literature that parents of ill neonates experience stress relating to matters such as family functioning, socio-economic status, and available sources of support (Carlson, Sampson & Sroufe 2003; Carter et al. 2007; Elgar et al. 2004; Martins & Gaffan 2000; Pinelli 2000). Research conducted by Carter et al. (2007) concludes that the high stress of parents with infants admitted to a NICU is associated with a lower household income and lack of family support.
A quantitative survey was conducted to investigate parents' perceptions of stress when their infants were admitted to a NICU, using the parental NICU stress model (Wereszczak et al. 1997) as the underlying framework.
This setting of the study was a NICU at a tertiary hospital in Kigali, Rwanda, with a 200 bed capacity and 6 NICU beds. The average number of admissions to that NICU during the nine months prior to this study was 13 patients per month with a length of stay of approximately two weeks per infant.
The population was 110 parents of infants admitted to a NICU at a tertiary hospital in Rwanda. Inclusion criteria for this study required parents to have an infant admitted to a NICU, to agree to participate, and the condition of the child had to be determined by the medical staff as stable to exclude any confound cause of additional stress for the parents. No sampling was carried out and all parents of children admitted to a NICU at a tertiary hospital in Rwanda at the time of data collection over a period of eight months (from August 2011 to March 2012) were included.
Data were collected using an existing 46 item self-report questionnaire, namely the PSS:NICU developed by Miles and Funk in 1987. This questionnaire has a well-established reliability and validity (Miles, Funk & Carlson 1993; Reid & Bramwell 2003). The PSS:NICU is a widely used tool to evaluate parental perception of stress experienced during NICU hospitalisation, that is, the experience which has caused parents to feel anxious, upset, or tense (Miles & Funk 1987). This scale identifies parental stress sources: the NICU physical environment, the change in parental roles, and the infants' appearance. Each item in the PSS:NICU asks the parent whether or not he or she has experienced a particular situation, for example, seeing the baby with tubes and equipment on or near him or her. Those parents who have had such an experience are asked to rate its stressfulness on a scale from 1 (not at all stressful) to 5 (extremely stressful). In addition to the Miles and Funk (1987) tool, the researcher added items that were related to the demographic characteristics of parents and infants in Rwanda. Permission to translate and use the tool in the Kinyarwanda language from English was obtained from the original developer. A language expert at the Kigali Health Institute translated the English PSS:NICU into Kinyarwanda and then back translated into English to ensure the meaning was not altered.
The psychometric properties of the PSS:NICU were originally evaluated in the USA and Canada by Miles et al. (1993) and was further assessed in studies by Franck et al. (2005), and Reid and Bramwell (2003). Internal consistency was good with alpha coefficients of 0.70 for each subscale in the original PSS:NICU and internal consistency for the total instrument ranged from 0.94 to 0.89. Inter-scale correlations showed moderate to strong correlations between the subscales and between the subscales and the total scores. The construct validity of the PSS:NICU was measured and found significant by comparing the scale scores with the scores of the state anxiety scale of State-Trait Anxiety Inventory (STAI) (Spielberger et al. 1983).
To ensure the validity and reliability of the PSS:NICU for use with Rwandan parents, a pilot study with four parents of infants admitted to a NICU had been conducted. The pilot study was carried out one week before the final study. The gaps revealed by results of that pilot study included misunderstood terms that respondents interpreted differently and unclear statements that would not generate required information accurately. These editing issues were addressed by the researcher by ensuring that the meaning of the language used was clear.
After obtaining permission to conduct the research from the Kigali Health Institute and the hospital administration, an appointment was made with the NICU manager. The parents were approached when they came to visit their children. Eligible parents were informed about the purpose of the study and asked to sign informed consent forms before they were allowed to participate in the study. All those parents who gave consent were asked to complete the questionnaires when it was convenient for them. The researcher collected the completed questionnaires on the day of the parents' visit to the NICU. Data were entered into a secure Statistical Package for the Social Sciences (SPSS) database.
All data were analysed using the SPSS version 16.0 and 21 computer program. Missing or incomplete data were excluded from the analysis. The data were arranged into subgroups of items that allowed a more meaningful examination of different dimensions. Descriptive statistics were used and results were expressed in the format of absolute numbers and percentages for nominal level data, and in mean values and standard deviations for continuous variables.
The PSS:NICU instrument can be scored either by calculating the frequencies of stressful experiences or by calculating two total scores. Metric 1: Stress occurrence level measures the level of stress produced when a situation occurs (in this study, only cases of parents who reported a stressful situation). Metric 2: Overall stress level measures the general stress from the environment (in this study, all cases whether exposed to a stressful situation or not) (Miles & Funk 1987). Metric 2 is used to describe the levels of stress parents have experienced whilst having an infant in a NICU. When the focus is on the NICU environment, Metric 1 (Stress occurrence level) is more useful to obtain a better understanding of the amount of stress each aspect of the environment causes (Miles & Funk 1987).
Scale scores were calculated by averaging those stress responses for the items on each scale and for the total scale. Independent samples obtained through the Kruskall Wallis and Mann Whitney U tests were used to examine the association between the characteristics of the parents and infants and the three general stress constructs of the PSS:NICU instrument, that is, infant appearance and behaviour, sights and sounds in the NICU, and adjustment in parental role.
There were 110 parents approached for the study with 98 responding. Of the parents who responded, 24 were fathers and 74 were mothers. Twelve potential respondents chose not to participate, citing time constraints as the reason for declining the invitation to participate.
Respondent ages ranged from 21 to 55 years, with the majority 38.8 % (n = 38) in the age range of 31 to 35, followed by 22.4% (n = 22) in the age range of 26 to 30 years. The mean respondent age was 31.98 years. Nearly all the respondents were married (96), were employed, with the majority (62.2%, n = 61) being publically and privately employed, and all respondents were educated with a marginal majority (52%, n = 51) at university level.
Most of the infants (90; 91.9%) were premature (< 36 weeks) with three extremely premature (< 28 weeks); the remaining eight were full term babies (> 36 weeks). The mean gestational age of the infants was 31.78 weeks (SD 3.1). As a result of the prematurity, most infants had an extremely low birth weight ranging from 600 g to 3.6 g, with a mean birth weight of 1.285.5 g (SD 737.8).
Based on the literature review and the NICU stress framework, situations that parents found stressful were reported by using two constructs: the appearance and behaviour of the baby, as well as the sights and sounds in the NICU.
Respondents rated this construct the highest with an average stress score of 3.8 SD 0.39 (95% CI 3.7–3.8) and an actual stress occurrence average score of 4.2 SD 0.31 (95% CI 4.2–4.3) out of a possible 5. The most stressful perceived behaviour occurred when a baby stopped breathing; all parents reported extreme stress responses. That was followed by a baby with a limp and weak appearance (93; 94.9%); 72 of those parents reported extreme stress reactions (Table 1).
Respondents rated this construct the second highest with an average stress score and actual stress occurrence score of 2.7 SD 0.7 (95% CI 2.6–2.9) out of a possible 5. Generally, the most stressful events were sudden noises or alarms (93; 94.9%) (Table 2), with 41 respondents who reported being extremely stressed. A significant number of parents (79; 80.6%) experienced stress when they saw a respirator or ventilator being used on a baby (Table 2).
Generally, parental role adjustments were rated more stressful than staff communication with an average stress score and actual stress occurrences average score of 2.3 SD 0.5 (95% CI 2.2–2.4) out of a possible 5 compared to 2.1 (2.0–2.1). In the main, the most stressful challenge for parents 98% (n = 96) was being separated from their babies. Not being able to share the baby with other family members was shown not to be stressful by 93.9% (n = 92) of the respondents (Table 3).
In terms of staff communication, the most stressful issue was staff not sharing enough information about tests and procedures (96; 98%), not conversing with parents frequently enough (89; 90.8%), and using too many words (80; 81.6%) (Table 4).
A significant association was found between parental age and general stress when confronted with an infant's appearance in a NICU with the older age groups reporting higher stress levels (K = 13.6, p = 0.004). Parents with only primary school level education also reported significantly higher stress levels (3.2 SD 0.5) in terms of the sights and sounds of the NICU than university graduates (2.6 SD 0.7) (K = 8.8, p = 0.012). There was no significant association between the parents' gender or marital status and the three constructs.
In terms of infant characteristics, perceived stress with regard to the parental role was higher for babies older than 36 weeks (K = 6.1, p = 0.046) and babies > 2500 g (K = 10.7, p = 0.013). Conversely, perceived stressed in relation to the appearance and the behaviour of a baby was higher in low weight babies < 1000 g (K = 9.8, p = 0.020).
Ethical approval was obtained from the Kigali Health Institute administration after approval by the appropriate institutional review board. Permission had also been obtained from the hospital where the study was conducted. To protect those vulnerable respondents, the researcher carefully observed each family member she approached to ensure each one of them was not stressed by completing the questionnaire; as a precautionary measure, psychological support was available. The parents were approached when they came to visit their children and eligible parents were informed about the purpose of the study and written consent was obtained prior to participation in the study. Parents were assured that their participation was voluntary, data could not be traced back to them, they could withdraw from the study at any time, and their refusal to participate would in no way affect the care that their child was receiving. All those parents who gave consent were asked to complete the questionnaires as and when it was convenient to them. The researcher collected the completed questionnaires on the day that the parents visited their children.
Three components of the results will be discussed.
The two situations that parents describe as stressful are the baby's appearance and behaviour, and the sights and sounds of the ICU. A baby's appearance is more stressful; this finding concurs with the findings of previous studies that have identified the physical appearance of an infant admitted to a NICU as the most significant source of stress for parents (Denney et al. 2006). On the other hand, Dudek-Shriber (2004) is convinced that parents experience a small degree of stress as a result of how their babies look and behave. The differences that occur in findings may be explained by the fact that each NICU has its unique context. There may also be culturally significant differences between other contexts and this population of Rwandan parents.
In terms of the experiences of stress in relation to the sights and sounds in a NICU, similar results are noted by Carter et al. (2007) and Singer et al. (2010). These studies state that sights, sounds, and the general environment of the NICU often cause stress and panic in the parents.
The main challenge faced by parents is the perceptions of the parental role adjustments. Dudek-Shriber (2004) and Steedman (2007) agree that the subscale in which parents reported their greatest stress is the parent-infant relationship. This finding is consistent with results of another study conducted by Carter et al. (2007) which found that adjustments in the parental role were the most stressful aspect of having an infant in a NICU.
Communication with staff is another challenge for parents. Parents believe that the importance of communication cannot be overemphasised, as stress is caused by poor or not sufficient explanations, and using too many words.
The effect of the educational level on the amount of stress that parents with an infant in a NICU experience has been explained in literature. Dudek-Shriber (2004) argues that parents with a high school education and higher education have higher stress frequency levels than parents who have not completed high school. These findings are consistent with the findings of this study. Given the scarcity of research in this area, this issue needs to be addressed further in order to explore the impact of educational level on the stress that parents with infants admitted to a NICU experience, especially in the cultural context of Rwanda. The findings of this study are consistent with the findings of a study conducted by Carter et al. (2007) which indicates that parents with low birth weight infants experience higher levels of stress than the ones with full term infants admitted to a NICU.
The sources of stress for parents with an infant admitted to a NICU have been explained and it is important for health professionals who practise in a NICU to be aware of these sources of stress in an attempt to reduce them where possible.
In-service education for nurses and doctors who work in a NICU can be implemented and the educational curriculum of nurses and doctors should also be interrogated in respect of these issues. In future studies, it may be appropriate to validate the usefulness of these components for Rwandan parents and further research, using a qualitative approach that could provide more detailed information about parental stress.
Generalisation of the current study findings is limited because data were collected from parents at one hospital and in one geographical location. In addition, the sample of this study was not representative of the entire population because of the nature of convenience sampling. Although self-report questionnaires are a valuable method in psychological research, sole reliance on such questionnaires is a limitation, as the potential for subjective bias exists; for example social desirability refers to the tendency of individuals to present themselves in a positive light according to social norms and values (Colman 2003).
The results of this study provide important information for health professionals who are working at the NICU in Rwanda. This information can be used to look at ways to reduce stress and mitigate adjustment and coping with regard to this stressful situation. This objective may be achieved by preparing and educating parents about their infants' tests, treatment, and general health condition. They should also be made part of the decision making about their infants. Priority should be given to train NICU staff with the aim of preparing and supporting parents in terms of the sights and sounds in a NICU. Policies that reduce parental separation from their infants would address a significant cause of stress for parents. All these strategies will assist with preventing or reducing stress for parents when their infants are admitted to a NICU
The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.
P.M. (University of Rwanda) carried out the conceptualisation of the study, data collection and analysis, and writing up of the article for publication. The research was carried out for higher degree purposes. Research supervisor P.B. (University of KwaZulu-Natal) carried out the conceptualisation of the study, support with collection and analysis of data, and writing up of the article for publication. J.C. (University of the Western Cape and University of Sydney) assisted with the data analysis and writing up of the article for publication.
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Etch & Ember
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Mozilla is trying to come up with a next-generation browser, but according to company executives, seems uncertain whether to retain the current Firefox technology or switch to something else, perhaps the same that powers Google's Chrome.
Last week, Mark Mayo, the head of Mozilla's cloud services engineering team, revealed that a new project, dubbed Tofino, is exploring options for a radical revision of Firefox.
"We're working on browser prototypes that look and feel almost nothing like the current Firefox," Mayo wrote in a long piece on Medium. "The premise for these experiments couldn't be simpler: what we need a browser to do for us -- both on PCs and mobile devices -- has changed a lot since Firefox 1.0."
A small sequestered team of Mozilla developers will work on Tofino for the next three months, at which time they must prove that a new browser is possible. If not, Mayo will kill Tofino and move on.
(The name came from a district on the west coast of Vancouver Island, where the idea originated last summer.)
How different a Firefox successor, or even replacement, might be from the current iteration remains unclear. But Mayo spent considerable wordage implying that Mozilla may dispense with Gecko, the browser engine that has powered Firefox since its debut in late 2004.
Mayo bemoaned the strains that arise when something new threatens the status quo in an organization. "The reason new things at old shops is difficult, mostly, I think, isn't because people are bad, or stupid, or actively sabotage new projects or any nonsense like that. It's largely because doing anything that might conceivably impact the current product creates unavoidable tension," Mayo wrote.
Then he dropped a bombshell that explained the stress. "The prototype we're feeling good about right now is built with Electron and React, not Gecko and XUL, our go-to technologies for building browsers," Mayo said.
A day later, Mayo clarified his comments about Electron and Gecko.
"I should have been clearer that Project Tofino is wholly focused on UX (user experience) explorations and not the technology platform," Mayo said in an April 8 update to his piece. "We are working with [Mozilla's] Platform team on technology platform futures, too, and we're excited about the Gecko and Servo-based futures being discussed."
But Mayo did not commit Tofino to Gecko, or even Servo, the four-year-old Mozilla project aimed at building a Gecko replacement using the Rust programming language, which also traces its roots to Mozilla's research division.
In another post, also on Medium, Mozilla CTO David Bryant, while speaking directly about embedding browser components within apps, trumpeted not Electron -- which targets that aspect of development -- but Gecko, Servo and other in-house technologies.
Bryant hinted that Gecko would survive as Firefox's heart when he pointed to yet another project, labeled Positron, that aims to integrate Electron's APIs (application programming interfaces) with Gecko.
It may be impossible to accurately parse Mozilla's plans for a future Firefox; the Tofino team will be isolated from the rest of Mozilla, a move Mayo cast as one to eliminate distractions, both for the Tofino group as well as the larger Mozilla. That means there's a tight lid on the former's work. But it's not that difficult to come up with reasons for all the activity.
Firefox, which accounts for the vast bulk of Mozilla's revenue, has been in trouble for years, gradually losing share to rivals, particularly Chrome. Since its peak six years ago, Firefox has shed more than half of its user share as measured by metrics vendor Net Applications.
Last month, Firefox dropped to a share of 10.5%, the lowest since May 2006, when it was busy battling Microsoft's Internet Explorer (IE) amid restarting the moribund browser wars.
Mayo tacitly acknowledged Firefox's troubles when he pointed out that the world is quite different than when version 1.0 appeared. "We're long overdue for some fresh approaches," Mayo said. "[And] it's worth noting that we have a ton of work underway on our flagship product, Firefox, that's all about evolving the browser experience."
Mozilla declined to answer questions about Tofino and the browser engine it may end up using. "We don't announce planned roadmaps for many of our experiments, including this one, because it is just starting," Jascha Kaykas-Wolff, the company's chief marketing officer, said in a emailed statement. "This is how we work and it is open to all. We will share what we learn as we go, as experiments turn into projects and even products."


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Story highlights
Katherine Russell "is doing everything" to help investigators, lawyer says
Russell saw her husband hours before he died, a source says
Tamerlan Tsarnaev was arrested for domestic violence a year before marriage
"She knew nothing about" her husband being a suspect, Russell's lawyer says
The widow of suspect Tamerlan Tsarnaev is "doing everything she can to assist with the investigation," of the Boston Marathon bombing, attorney Amato DeLuca said in a statement Tuesday.
Katherine Russell last saw her husband Thursday, just hours before he died in a gun battle with police, according to a source close to the family. She was handing off her 2-year-old daughter to stay with him while she went to work, the source said.
The FBI wants to interview Russell about her husband, but for now, agents only have been able to talk to her lawyer.
"She knew nothing about it at any time," DeLuca told CNN's Chris Lawrence, referring to the bomb plot.
Russell, 24, learned through news reports that the father of her daughter was suspected in the attack, DeLuca said. "That's my understanding."
Hearing that news devastated her, he added, saying Monday that she's "very distraught" and "cries a lot."
"The reports of involvement by her husband and brother-in-law came as an absolute shock to them all," DeLuca's Tuesday statement said. "As a mother, a sister, a daughter, a wife, Katie deeply mourns the pain and loss to innocent victims – students, law enforcement, families and our community. In the aftermath of this tragedy, she, her daughter and her family are trying to come to terms with these events."
Timeline: A look at Tamerlan's past
"The whole family is a mess, to put it bluntly," he said Monday. "They're very distraught. They're upset. Their lives have been unalterably changed. They're upset because of what happened, the people that were injured, that were killed. It's an awful, terrible thing."
Tsarnaev's domestic violence arrest
Tsarnaev and Russell met when she was a student at Suffolk University in Boston, although it is unclear when they began dating. The couple married on June 21, 2010, according to marriage records at the Cambridge City Hall.
Eleven months earlier, Tsarnaev was arrested, accused of domestic assault and battery against his girlfriend at his home in Cambridge, police records said.
The police report was redacted to hide the girlfriend's name, and a police spokesman would not confirm it was Russell.
The woman, who was "crying hysterically," called 911 to report that she was "beat up by her boyfriend" on the afternoon of July 28, 2009, Cambridge Police Officer Angela Pereira wrote in the arrest report.
Tsarnaev told Pereira and another officer that his girlfriend "was yelling at him because of another girl."
Suspect says brother was brains behind attack
"I asked the suspect if he had hit the victim, and he stated 'Yes, I slapped her,' " Pereira wrote.
The girlfriend told police Tsarnaev hit the left side of her face. "No visible marks were seen," Pereira said.
NPR's Laura Sullivan reported Friday on an interview with unnamed women she described as Russell's close friends and college roommates.
"They described Tamerlan as very controlling and very manipulative of their friend," Sullivan said. "They say he was combative and angry. He would often call (Russell) names and insult her. He would call her a slut and a prostitute, and they remember fights that they would get into where he would fly into rages and sometimes throw furniture or throw things."
Russell dropped out of school after she became pregnant in her senior year, the women told Sullivan. "They say that she really pulled away from her friends, that she cut off contact with them, and she also cut off contact with her family members which her friends had been in contact with," she reported.
Did one brother brainwash the other?
Wife is staying with parents
Russell was born and raised in suburban Providence, Rhode Island, a Christian who converted to Islam after marrying Tsarnaev. She's an observant Muslim and wears a headscarf, her lawyer said.
Katie – that's what family and friends call her – is staying now with her parents in North Kingstown, Rhode Island, but before last week she was living in Cambridge and working as a home health aide, he said. "She worked many, many hours."
Her husband took care of their daughter each day while she was at work, her lawyer said.
"She would go off in the morning, she would work 'til late at night," he said. "She called to see how her daughter was and that kind of stuff, like any person would."
Widow is not talking yet
The Russell family hired DeLuca on Saturday, after federal agents contacted them asking to interview her, he said. For now, he is the one speaking to the FBI.
"She understands the need for doing it," he said. "This is the way the government looks at it, and she understands this. It's a threat to national security, and she gets that. And she's a really good person, very sympathetic to that. Katie's just trying to bring up her daughter."
What we know about the suspects
In the statement released Tuesday, DeLuca said Russell is very close to her family.
"She is fortunate to have the support of her loving family now, as they, too, struggle to come to terms with these events and the deep sorrow we all feel following the events of last week," he said. "The injuries and loss of life – to people who came to celebrate a race and a holiday – has caused profound distress and sorrow to Katie and her family."
The family released its own statement Friday, after learning Tsarnaev had died.
"Our daughter has lost her husband today, the father of her child," the family said. "We cannot begin to comprehend how this horrible tragedy occurred. In the aftermath of the Patriots' Day horror, we know that we never really knew Tamerlan Tsarnaev. Our hearts are sickened by the knowledge of the horror he has inflicted. Please respect our family's privacy in this difficult time."
FBI agents interviewed Tamerlan in 2011
CNN's Rachel Streitfeld contributed to this report.


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Every now and then I come across a site that reminds of just why I love this sad and beautiful world wide web: a site with that certain intangible
Wikipedia has it. That's a project that's not just on the web, it's of the web. It's a terrible idea in theory, but an amazing achievement in practice. It restores my faith in humanity.
Kickstarter has it. The word
distruptive is over-used in the world of technology, but I can't think of a better adjective to describe Kickstarter …except, perhaps, for
empowering. There's something incredibly satisfying about contributing directly to someone's creative output.
Old Weather has it. It's the latest project from the magnificent Zooniverse crew, the people behind the brilliant Galaxy Zoo.
Old Weather is another collaborative project. Everyone who takes part is presented with a scanned-in page from a ship's logbook from the early 20th Century. The annotations on the pages aren't machine-readable but the human brain does an amazing job of discerning the meaning in the patterns of markings made with pen on paper (and if you need help, there are video tutorials available).
Converting this data from analogue paper-based databases into a digital database online would in itself be a worthy goal, but in this case, the data is especially valuable:
These transcriptions will contribute to climate model projections and improve a database of weather extremes. Historians will use your work to track past ship movements and the stories of the people on board.
But the value is not just in contributing to a worthy cause; it's also great fun. It makes excellent use of the cognitive surplus that Clay Shirky talks about.
What a shame that the situation in which we are most often called upon to demonstrate our humanity is through the vile CAPTCHA, a dreadful idea that is ironically dehumanising in its implementation.
I'd much rather have people prove their species credentials with a more rewarding task. Want to leave a comment? First you must calculate the optimum trajectory for a Jupiter flyby, categorise a crater on the moon spot a coronal mass ejection or tell me if you live in fucking Dalston.


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Outer Fox Islands 1 Framed Fine Art Print - IN STOCK NOW
This Fine Art print is currently in stock at 18 James Street in Parry Sound. If you purchase this print it can only be picked up in store, not shipped.
If you're a fan of high-quality fine art prints that are matted and framed in a more traditional style, these larger prints of original paintings by Parry Sound artist Jessica Vergeer may be just what you're looking for. These prints are the perfect addition to any home, cottage or office space that needs an inspiring and artful touch!
This print features Jessica's original Outer Fox Islands 1 painting. The print measures 18"x24", is mounted with a 3" mat, is finished with a solid wood gallery-style 1.5" frame in black. We use UV art glass for with the print if picked up at 18 James Street, and high-quality plexiglass for if shipping is required. The finished outer frame dimensions of this print measure 27" tall by 33" wide.
Each print is this collection is printed on premium, 100% cotton paper that's acid-free for a long print life. This fine art paper is silky smooth with a matte white surface to ensure incredible detail and accurate colours.
The print is mounted with a 3" mat, helping to provide protection to the print while adding visual appeal and size. The frame is solid wood, matte black in a traditional gallery style measuring 1.5". We choose UV Art Glass for these prints (pickup orders only) as it has the lowest visible light reflection, tuned for unparalleled clarity and colour correctness.
Unless otherwise specified, all prints are made to order and should be ready for pickup within 3 weeks of your order date. Unfortunately we cannot offer free shipping with these prints, but we can offer you a cost-effective shipping option if required, so please just ask!