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Background: Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub‐Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub‐Saharan African countries. Methods: A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. Results: One hundred and sixty‐six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient‐controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty‐eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. Conclusion: This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non‐pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques. [ABSTRACT FROM AUTHOR]

Background: Premature neonates often experience feeding difficulties during their hospital stay, and evidence‐based interventions have been shown to improve feeding outcomes. Aim: This study investigated whether an infant‐cue based nurse educational feeding bundle accelerates the achievement of independent oral feeding in neonates in a neonatal intensive care unit. Study Design: A quality improvement study with a pre, during and post intervention test design. All premature neonates admitted to the unit were eligible. The feeding programme included a four‐month nurse training module and nurse coaching. Results: A hundred and twenty‐five nurses or nurse assistants attended the programme and 706 neonates were included. The median time to independent oral feeding (IOF) was 40, 36 and 37 days, respectively, for pre, during and post intervention. The reduction in time to IOF observed during the post‐intervention period compared with the baseline period was significant (HR = 1.32, CI 95%: 1.01–1.74). No difference was noted in the length of hospital stay between the three study periods. Conclusions: An infant‐cue based nurse educational feeding bundle can promote earlier achievement of IOF in preterm neonates. Relevance to Clinical Practice: This quality improvement study demonstrates the impact that a nurse‐driven intervention in neonatal care can have on improving practice. Feeding interventions involve the early introduction of oral feeding, non‐nutritive sucking (NNS), and oral motor stimulation, and should be individualized for each neonate. These individualized feeding interventions applied by all nurses and assistant nurses, can facilitate the achievement of earlier independent oral feeding in preterm infants and should be included in neonatal critical care nurse education programs. [ABSTRACT FROM AUTHOR]

Fever is the most common clinical sign during infancy. Nurses deal with fever in children most directly and it is an integral aspect of their role as pediatric nurses. The objective of this study is to analyze the perceptions, knowledge and attitudes toward childhood fever of nurses in three health contexts: pediatric hospitalization, pediatric emergency and primary care. To respond this objective, a qualitative study with ethnomethodological approach has been carried out. In-depth interviews were conducted and theoretical clinical cases were presented to nurses working in pediatrics in the three settings studied. After the analysis of the discourses, the codes were classified into three categories: static and number-centric knowledge, dependent nursing attitude, and unconscious model nurses. On the one hand, when we analyze and compare the perceptions, attitudes and knowledge of the nurses between the different contexts, we find differences that consist mainly of what the context requires of them. On the other hand, in general and regardless of the context, the nurses interviewed place themselves in a traditional framework when faced with the phenomenon of fever in children. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic deeply affected the lives of children and young people; studies report adverse effects on mental, physical, and social well-being. However, the impact of the pandemic on obesity care for children received little attention. The aim of this study was to gain insight into the challenges youth healthcare nurses experienced and to describe implications for future obesity care and policy. We conducted interviews, participant observations, and a group session with youth healthcare nurses during the pandemic in Amsterdam, the Netherlands. Youth healthcare nurses reported a deterioration in the problems of children and young people who were already in the highest classification for pediatric obesity, such as increased weight gain, mental health problems, and socio-economic problems. The nurses experienced immense challenges while trying to provide obesity care, such as a decrease in face-to-face contact with youth and their families, as well as loss of continuity of care. It is important to reconnect with these families, invest in a trusted relationship with youth receiving obesity care, and prioritize available and accessible obesity care for those who need it the most. [ABSTRACT FROM AUTHOR]

Introduction: With improved survival in pediatric solid organ transplantation (SOT) care has focused on optimizing functional, developmental, and psychosocial outcomes, roles often supported by Allied Health and Nursing professionals (AHNP). However, there is a scarcity of research examining frameworks of clinical practice. Methods: The International Pediatric Transplant Association AHNP Committee developed and disseminated an online survey to transplant centers as a quality improvement project to explore AHNP practice issues. Participant responses were characterized using descriptive statistics, and free‐text comments were thematically analyzed. Responses were compared across professional groups; Group 1: Advanced Practice Providers, Group 2: Nursing, Group 3: Allied Health. Results: The survey was completed by 119 AHNP from across the globe, with responses predominantly (78%) from North America. Half of respondents had been working in pediatric transplant for 11+ years. Two‐thirds of respondents were formally funded to provide transplant care; however, of these not funded, over half (57%) were allied health, compared to just 6% of advance practice providers. Advanced practice/nursing groups typically provided care to one organ program, with allied health providing care for multiple organ programs. Resource constraints were barriers to practice across all groups and countries. Conclusion: In this preliminary survey exploring AHNP roles, professionals provided a range of specialized clinical care. Challenges to practice were funding and breadth of care, highlighting the need for additional resources, alongside the development of clinical practice guidelines for defining, and supporting the role of AHNP within pediatric SOT. Professional organizations, such as IPTA, can offer professional advocacy. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has significantly affected nursing, as nurses are crucial in providing healthcare services. Understanding the factors influencing nurse retention is essential for maintaining a strong and long‐lasting workforce because nurse retention is becoming increasingly complex. This study aimed to investigate the influence of professional identity and job satisfaction on the intention to remain employed while also evaluating the levels of professional identity, job satisfaction, and intention to stay among paediatric nurses amidst the COVID‐19 pandemic. This correlational and descriptive study included a stratified sample of 257 paediatric nurses and was guided by the STROBE checklist. Data were collected through valid and reliable questionnaires, which included a nurses' professional identity scale, job satisfaction survey, intention to stay scale, and a demographic questionnaire. Data collection was conducted from January to April 2022. The study was approved by the ethical research committee at the Nursing Faculty – Mansoura University, ensuring adherence to the Helsinki Declaration. The paediatric nurses reported elevated professional identity, moderate job satisfaction, and moderate intention to stay employed with mean scores of 80.35 ± 13.22, 113.70 ± 19.58, and 8.40 ± 3.55, respectively. Multiple regression explained 13.0% of the variation in paediatric nurses' intention to remain employed (F = 18.50, p < 0.001). Professional identity positively correlated with the intention to stay (β = 2.69, p = 0.008). Job satisfaction also had a positive relationship with the intention to stay (β = 3.49, p < 0.001). Healthcare managers should focus on professional identity strategies such as supportive work environments, growth opportunities, and valuing paediatric nurses' contributions. Implementing interventions such as fair compensation, support, and rewards can enhance paediatric nurses' retention and quality of patient care. [ABSTRACT FROM AUTHOR]

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of 'narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. [ABSTRACT FROM AUTHOR]

Effective communication in end‐of‐life care for pediatric cancer patients is crucial. Yet, limited research focuses on the communication experiences of pediatric oncology nurses during this period. This study aims to investigate the communication experiences and needs of these nurses with children and their families during the end‐of‐life period. A qualitative study design with photo voice methodology was followed. The research was conducted with 16 pediatric oncology nurses working in the pediatric oncology wards of a university hospital between January and May 2023. Data were collected the "Characteristic Information Form", "Semi‐Structured Interview Form", and photovoice methodology. Data were analyzed through reflexive thematic analysis. Most of the nurses are at the undergraduate level, and their working experience in pediatric oncology wards ranges from 4 months to 17 years. Seven main themes emerged: Optimistic Communication‐Interaction, Mindfulness, Active Coping, Behavioral Actions, Death Uncertainty Dilemma, Interpersonal and Environmental Factors, and Discrepancy between Ideals and Reality. The study sheds light on the importance of pediatric oncology nurses' ideals versus realities upstream approach in communicating with end‐of‐life children and their families, empowering pediatric oncology nurses on the journey to ideal end‐of‐life care. [ABSTRACT FROM AUTHOR]

Misdiagnosis of child abuse and neglect can delay early treatment. Some authors have pointed out that nurses can miss child abuse and neglect diagnoses due to a lack of knowledge. It is unclear whether the lack of knowledge is due to students' insufficient preparation in nursing school and/or a deficiency in continuing education. An 18‐item questionnaire was administered to final‐year nursing students to assess their degree of knowledge on child abuse and neglect and to evaluate if the lack of knowledge was due to insufficient teaching/training during nursing school. The students were also asked to evaluate themselves by assigning a score to their knowledge. A statistical comparison was performed to define whether sufficient/insufficient results were associated with the following variables: sex, pediatric or general nursing student, attending pediatric lectures, training in pediatric wards/ambulatories, and attending specific lectures on child abuse and neglect. The study population comprised 175 students (154 females, 20 males, 1 unknown). Exactly 66.3% of the participants had ≤9/18 correct answers. Of all students, 77.7% self‐evaluated their level of knowledge as ≤5/10. The comparisons yielded statistically significant differences between the groups with sufficient objective knowledge and those unrelated to training in pediatric wards/ambulatories or pediatric nursing students. Overall, there was little objective knowledge on the subject, which may be related to insufficient teaching/training in nursing schools. Useful corrective strategies include further teaching on child abuse and neglect, preferably using a practical approach. Further, common teaching/training programs should be conducted by both pediatric and general nursing schools. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Peripheral intravenous catheter (PIVC) insertion can be challenging in children, with point‐of‐care ultrasound (POCUS) known to increase success rates. The objective of this study was to survey how emergency department (ED) clinicians identify and escalate paediatric patients with difficult intravenous access (DIVA), specifically the use of POCUS. Methods: This cross‐sectional study was conducted in an Australian academic mixed ED that surveyed resident medical officers (RMOs), registrars, consultants and senior paediatric nurses. A 15 multiple‐choice questionnaire evaluated clinicians experience with paediatric PIVC insertion, approach to identifying and managing DIVA and the use of POCUS or other adjuncts. Results: Eighty clinicians (34.2% response rate) completed the survey. Poor vein palpability was rated the highest predictor of DIVA. Of the respondents, 19 consultants (86.4%), 28 registrars (90.3%) and 16 RMOs (64.0%) used POCUS as an adjunct for paediatric DIVA patients but 16 consultants (72.8%), 21 registrars (67.8%) and 20 RMOs (80.0%) would use this less than 25% of the time in clinical practice. Discussion: This survey suggests more clinicians to prefer using objective factors when identifying paediatric DIVA patients, rather than subjectively using gestalt, which relies on clinician experience. Whilst clearly recognised as a useful tool in our study, POCUS was used infrequently for paediatric DIVA patients. Conclusions: There is currently no consistent process for the identification and escalation of paediatric DIVA patients, including the use of adjuncts such as POCUS. Clinician awareness for these issues should be addressed, which should include the development of guidelines and clinician training in POCUS for PIVC insertion in children. [ABSTRACT FROM AUTHOR]

Background: Nurse‐sensitive outcomes are measures for improvement and evaluation of the quality of nursing care delivered. The specific outcomes that need to be measured will be determined by the patient population, as well as the field and scope of practice, in which nursing care is being delivered. Currently, there is no internationally agreed upon set of nurse‐sensitive outcomes for pediatric nursing, which provides specialist care to infants, children, and young people. Aim: To identify and evaluate nurse‐sensitive outcomes for pediatric nursing. Methods: A systematic review was conducted. Five electronic databases (British Nursing Index, CINAHL, EMBASE, MEDLINE, and EMCARE) were searched in the period up to February 2022. Studies were selected for inclusion using title and abstract screening using predetermined criteria. The Critical Appraisal Skills Programme tool was used for quality assessment. A narrative synthesis of the results was performed. Results: A total of 633 studies were identified from online searches, with 14 studies meeting the inclusion criteria. All studies had moderate to high methodological strength. A total of 57 nurse‐sensitive outcomes were identified from all included studies. Using the nurse‐sensitive outcome conceptual analysis framework, 25 (45%) of the items were classified as outcome attributes, 20 (35%) as process attributes, and 13 (23%) as structure attributes. The most frequently reported nurse‐sensitive outcomes included pressure ulcers, nosocomial infections, hospital‐acquired infections, peripheral intravenous infiltration, failure to rescue, and staffing levels. Conclusions: This review provides an up‐to‐date and comprehensive list of nurse‐sensitive outcomes for use in pediatric nursing and describes their frequency of use. However, further work is required to achieve consensus for an international core nurse‐sensitive outcome set for pediatric nursing with policy recommendations to ensure agreed‐upon minimum standards. Implications for nursing and health policy: Policy initiatives and guideline recommendations on nurse‐sensitive outcome frameworks as part of patient safety should be a part of key priorities for policy makers. The commonly reported nurse‐sensitive outcomes should be incorporated into daily bedside pediatric clinical nursing practice as a mechanism to evaluate and improve the quality of care, enhancement of patient safety, and better outcomes. [ABSTRACT FROM AUTHOR]

Background: Nurses play an essential role in pain management in the pediatric intensive care unit (PICU). However, their perceptions regarding pediatric pain and current practice of pain assessment in Japanese PICUs remain unknown. Methods: In January 2021, we conducted a multicenter, cross‐sectional survey across 35 PICUs in Japan. A structured questionnaire which focused on nurses' perceptions of pediatric pain and pain assessment was developed, pilot‐tested, and revised. Twenty copies of the questionnaire were sent to each institution and were distributed to the nursing staff. Results: A total of 356 nurses from 22 institutions responded. Median age of the respondents was 33 years and 84.6% were female. Median length of nursing experience and PICU experience were 10 and 4 years, respectively. Use of pain scales for assessing pain in children who can self‐report pain, preverbal children, and children unable to self‐report pain due to cognitive impairment were 90.7%, 55.9%, and 50.0%, respectively. Nurses' satisfaction regarding pain management in their PICU was 31.9% and their confidence in pain assessment and management were 32.6% and 44.9%, respectively. Lack of knowledge (95.8%), difficulty assessing pain in children (95.2%), and delay in physician's action (91.8%) were the most perceived barriers to optimal pain management. Conclusions: The use of pain scales is insufficient and nurses' satisfaction proved to be extremely low in the Japanese PICUs. Substantial effort is required to enhance the level of current pain management and improve outcomes. [ABSTRACT FROM AUTHOR]

Problem: Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital. Methods: A two group pretest–posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention. Findings: There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p <.001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups. Conclusion: Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes. [ABSTRACT FROM AUTHOR]

The current study focused on pediatric nurses. It explored the direct link between posttraumatic growth as a coping resource and burnout and the indirect link between posttraumatic growth and burnout via secondary traumatic stress (mediating effect). Moreover, meaning in work was examined as a moderator variable in relation to the direct link and the indirect link. One hundred and thirty‐eight nurses working at a pediatric medical center filled out self‐report questionnaires regarding personal and professional data, burnout, posttraumatic growth, secondary traumatic stress, and meaning in work. Posttraumatic growth was found to be a coping resource that linked to pediatric nurses' burnout directly and indirectly. Directly, there was an inverse correlation between the two; indirectly, posttraumatic growth linked negatively to secondary traumatic stress, and secondary traumatic stress linked positively to burnout. Moreover, meaning in work played a dual moderating role. First, it moderated the relationship between posttraumatic growth and secondary traumatization. Second, it moderated the direct relationship between posttraumatic growth and burnout, namely, the negative link between posttraumatic growth and burnout became stronger as meaning in work increased. As such, we recommend enhancing personal and professional posttraumatic growth, as well as designing interventions that promote meaningful work among pediatric nurses. [ABSTRACT FROM AUTHOR]

Aim: Perinatal death is often preceded by an end-of-life decision (ELD). Disparate hospital policies, complex legal frameworks and ethically difficult cases make attitudes important. This study investigated attitudes of neonatologists and nurses towards perinatal ELDs.Methods: A survey was handed out to all neonatologists and neonatal nurses in all eight neonatal intensive care units in Flanders, Belgium in May 2017. Respondents indicated agreement with statements regarding perinatal ELDs on a Likert-scale and sent back questionnaires via mail.Results: The response rate was 49.5% (302/610). Most neonatologists and nurses found nontreatment decisions such as withholding or withdrawing treatment acceptable (90-100%). Termination of pregnancy when the foetus is viable in cases of severe or lethal foetal problems was considered highly acceptable in both groups (80-98%). Physicians and nurses do not find different ELDs equally acceptable, e.g. nurses more often than physicians (74% vs 60%, p = 0.017) agree that it is acceptable in certain cases to administer medication with the explicit intention of hastening death.Conclusion: There was considerable support for both prenatal and neonatal ELDs, even for decisions that currently fall outside the Belgian legal framework. Differences between neonatologists' and nurses' attitudes indicate that both opinions should be heard during ELD-making. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess Jordanian neonatal nurses' knowledge and beliefs toward the application of kangaroo mother care in the neonatal intensive care unit. A cross‐sectional, descriptive survey was performed using a convenience sample of 229 nurses. The findings revealed that the majority of the nurses agreed that kangaroo mother care was beneficial to both mothers and infants; however, 47.2% believed that it was not feasible for all preterm infants. The majority of nurses believed that kangaroo mother care should be restricted to infants on intravenous treatment, intubated, or with an umbilical catheter. The majority of the nurses correctly answered questions regarding kangaroo mother care. A significant relationship was found between the nurses' knowledge and their beliefs toward kangaroo mother care. The findings of this study provide insights into Jordanian nurses' knowledge and beliefs toward the kangaroo mother care approach. If addressed, these findings will help improve the practice and nursing care for preterm infants. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate the psychometric properties of the Korean‐language versions of Pain Knowledge and Use (PKU‐K), Collaboration and Satisfaction About Care Decisions (CSACD‐K), and Environmental Complexity Scale (ECS‐K). Methods: A cross‐sectional design was used with a convenience sample of 159 Korean nurses in seven neonatal intensive care units (NICUs). The data were collected by surveying the nurses with the PKU‐K, CSACD‐K, and ECS‐K. Internal consistency reliability was assessed and Horn's parallel analysis, a confirmatory factor analysis, and a convergent construct validity test were conducted in order to evaluate the psychometric properties of the instruments. Results: The PKU‐K, CSACD‐K, and ECS‐K exhibited strong internal consistency reliability. Horn's parallel analysis showed four factor structures for the PKU‐K, one for the CSACD‐K, and three for the ECS‐K. The confirmatory factor analysis showed a good model fit for the PKU‐K and CSACD‐K, but the ECS‐K model showed a poor fit. Most factor loadings were statistically significant. The CSACD‐K's convergent validity was supported by significant correlations for collegial nurse–physician relations with a validated instrument. Conclusion: The findings support the reliability and validity of the PKU‐K, CSACD‐K, and ECS‐K for measuring nurses' knowledge about neonatal pain care, nurse–physician collaboration, and the work environment in NICUs. However, the ECS‐K needs further refinement before it is applied to Korean NICU nurses. [ABSTRACT FROM AUTHOR]

Background Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. Problem No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. Purpose To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. Methods Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. Conclusions The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. Clinical Relevance Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention. [ABSTRACT FROM AUTHOR]

The authors explored this sensitive topic, by surveying the self-reported attitudes of neonatologists and neonatal nurses in the Flanders region of Belgium. Marie Friedel, paediatric nurse; Dr Marleen Renard, paediatrician, Prof. Hugo Devlieger neonatologist; Prof. Gaston Verellen, paediatrician, neonatologist, professor emeritus. Neonatologists and neonatal nurses have positive attitudes towards perinatal end-of-life decisions, a nationwide survey. [Extracted from the article]

Purpose: The objectives of this study were to describe (a) the frequency of interruptions experienced by a pediatric nurse per hour, (b) the sources of interruptions experienced by a pediatric nurse, and (c) the interruption outcomes during pediatric medication administration. Design and Methods: This design of this study was a cross‐sectional observational study. A convenience sample of pediatric nurses was used in this study. The interruption observation sheet was used to collect data about the frequency, sources, and outcomes of interruptions. Results: There was a total of 43 nurses were observed in more than 180 medication administration rounds. An interruption rate of 94.51% occurred during pediatric medication administration. The frequency of interruptions was three or more times (51.04%). The most common source of interruption was attributed to the working environment (32.37%). The second most frequent reason for interruption came from personnel, such as caregivers (24.48%), followed by physicians (10.79%), and other nursing staff (9.54%). The third most common source of interruption was communication issues, including patient interviews, patient reports, and case discussion (8.71%). Six errors (2.49%) were reported out of 241 interruptions as a result of interruptions. In specific, causes of errors during pediatric medication administration were due to wrong medication dose. Practice Implications: This study provides important information on interruptions experienced by pediatric nurses during medication administration in Chinese hospital settings and found that interruptions frequently occur in pediatric units. [ABSTRACT FROM AUTHOR]