Course: IB300, Advanced Computer Sciences Mid Term Exam WARNING: Caution: Any Copy and Paste from the Internet will be detected and will result in an automatic "F". There will be no second chances given. Part 1 1- Define a local computer network? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2- What is the difference between a network node and a network host? Give an example of each _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 3- What is the use of a computer modem? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4- Define a Public IP address? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5- State an example where you would need a static Local IP address? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 6- It is said that ISP’s are hierarchical. What does that mean? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 7- Which Protocol(s) (TCP/IP, UDP, FTP, DNS, VOIP) do we use when doing the following operations: Chatting on skype using Text and using Webcam: _______ Talking voice and sending images using whatsapp: _______ Entering Credit Card information on Amazon: _______ 8- What does DNS stand for and what does it do? __________________________________________________________________________________________________________________________________________________________________________ 9- Define TCP/IP and Briefly describe how it works? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 10- How can you find out the public IP address of Amazon.com? _____________________________________________________.

1. Course: IB300, Advanced Computer Sciences
Mid Term Exam
WARNING: Caution: Any Copy and Paste from the Internet will
be detected and will result in an automatic "F". There will be no
second chances given.
Part 1
1- Define a local computer network?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
2- What is the difference between a network node and a network
host? Give an example of each
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
3- What is the use of a computer modem?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
4- Define a Public IP address?
_____________________________________________________

2. _____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
5- State an example where you would need a static Local IP
address?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
6- It is said that ISP’s are hierarchical. What does that mean?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
7- Which Protocol(s) (TCP/IP, UDP, FTP, DNS, VOIP) do we
use when doing the following operations:
Chatting on skype using Text and using Webcam: _______
Talking voice and sending images using whatsapp: _______
Entering Credit Card information on Amazon: _______
8- What does DNS stand for and what does it do?
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________
9- Define TCP/IP and Briefly describe how it works?
_____________________________________________________
_____________________________________________________

3. _____________________________________________________
_____________________________________________________
___________________________________________
10- How can you find out the public IP address of
Amazon.com?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
______________________
11- What is the major international incident that led to the
creation of ARPA
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
12- State two drawbacks of using file systems for Data Bases
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________________________________
13- What is SQL stands for and what does it do?
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________
14- The Internet and World Wide Web are NOT the exact same
thing:

4. True
False
Part 2: Network Troubleshooting
Tiger electronics is a known tech company that has just
purchased a new building that will be used for housing Four
departments: HR, Finance, Engineering and Logistics.
The HR department is made of 4 employees and will occupy
Floor 1. Finance consist of 6 employees and will occupy F2.
Logistics has 5 employees and will occupy F3. Engineering
consistes for 3 Emplyees and is located in the Basement.
The company has ordered a phone line and DSL internet
connection of 12 Mbps.
A- How many switches and routers does Tiger electronics need
to get all the employees access to the network.
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_______________________________________________
B- Draw the network diagram of Tiger Electronics’ new
building

5. C- Mr Smith from the Logistics department has no Internet
access, but has access to the network. Knowing that the rest of
his team have all access to the internet, state one possible
reason that can cause such issue.
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
______________________
D- The company wants to order three printers and give access to
all employees for printing. Where should these 3 printers be
installed and how (state and Draw your answer)?
_____________________________________________________
_____________________________________________________
__________________________________________________
E- All equipment is connected to the network, however there the
company has no internet. State three possible reasons for such

6. issue.
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
______________________
F- The company decided to add a small office on the roof for
the security guard. After running a cable from the router
(located in the basement), the computer on the roof seem to
have internment and slow connection due to the network cable
being too long. What would be the best way to fix such issue?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
____________________________________________
Original
Article. . . . . . . . . . . . . .
Preterm Infant Thermal Responses to Caregiving Differ
by Incubator Control Mode

7. Karen A. Thomas, PhD, RN
OBJECTIVE:
To determine the influence of caregiving on preterm infant and
incubator
temperature and to investigate incubator control mode in
thermal responses
to caregiving.
STUDY DESIGN:
The intensive within-subject design involved continuous
recording of
infant and incubator temperature and videotaping throughout a
24-hour
period in 40 hospitalized preterm infants. Temperature at care
onset was
compared with care offset, and 5, 10, 15, and 20 minutes
following care
offset using ANOVA-RM.
RESULTS:
Following caregiving, infant and incubator temperature differed
significantly over time by incubator control mode. In air servo-
control,
infant temperature tended to decrease after caregiving, while in

8. skin
servo-control infant temperature remained relatively stable.
With
caregiving, incubator temperature remained consistent in air
servo-
control and increased in skin servo-control.
CONCLUSIONS:
The temperature effects of caregiving should be considered
relative to
maintenance of thermoneutrality and unintentional thermal
stimulation.
Journal of Perinatology (2003) 23, 640 – 645.
doi:10.1038/sj.jp.7211002
INTRODUCTION
The purpose of this study was to determine the influence of
caregiving activities on preterm infant and incubator
temperature.
Specific research questions included: (1) What is the effect of
caregiving, defined as care clusters, on infant and incubator
temperature at care offset, and at 5, 10, 15, and 20 minutes
following care offset compared with temperature at care onset?
(2) Does incubator control mode effect infant and/or incubator
temperature responses to caregiving?
Thermal care has been termed the cornerstone of neonatal
care.

9. 1 Simulation models have demonstrated infants’ profound
capacity to exchange body heat with the environment.2
Provision of
a supportive thermal environment minimizes metabolic
requirements, a basic objective of neonatal care.3 Because
thermal
capability is exponentially correlated with gestational age,4
management of the thermal environment requires close attention
in preterm infants who are particularly prone to both hyper- and
hypothermia. Temperature management is related to infant
outcomes. In one study of six neonatal intensive-care units
hypothermia (body temperature <961F) was statistically
significant factor increasing neonatal illness severity.5
Incubators provide a micro-environment suited to the infant’s
thermoregulatory abilities. Incubators are operated in skin
servo-
or air servo-control modes and these operation modes
produce differing patterns of incubator and infant temperature.6
While incubator control appears straightforward, the regulation
of
incubator and infant temperature is complex. External thermal
perturbations, such as initiation of phototherapy, produce large,
sustained changes in incubator thermal environment requiring
up
to 3 hours to reach new equilibrium.7 Aside from the thermal
control of the ambient room temperature, three control systems
are
in effect: the infant’s thermoregulatory control, the incubator’s
set
point, and the caregiver making adjustments to the incubator set
point. The ongoing interaction of these control systems is
further

10. complicated by one extremely important condition: the
incubator is
not a closed system. Caregiving involves opening the incubator,
potentially disrupting incubator temperature. In addition to
shifting infant temperature, alterations in incubator temperature
also produce wide-ranging responses. In a study of the effects
of
cool exposure in preterm infants (34±2 weeks gestational age,
22±1 days postnatal age), air temperature 1.51C less than
thermoneutrality resulted in state change.
8
Neonatal care providers have struggled with balancing needed
caregiving against the physiologic costs of disrupting infants.
Caregiving has been shown to produce a variety of
physiological
responses including hypoxia, heart and respiratory changes,
Address correspondence and reprint requests to Karen A.
Thomas, PhD, RN, Department of
Family and Child Nursing, University of Washington, Box
357262, Seattle, WA 98195-7262, USA.
Research supported by a grant awarded from the National
Center for Nursing Research, R29
NR02420.
Statistical consultant: Robert Burr, PhD, MSEE, Department of
Biobehavioral Nursing and Health
Systems, University of Washington.
Department of Family and Child Nursing, University of

11. Washington, Seattle, WA, USA.
Journal of Perinatology 2003; 23:640 – 645
r 2003 Nature Publishing Group All rights reserved. 0743-
8346/03 $25
www.nature.com/jp640
distress cues, and sleep – wake state disturbance.9,10 – 15 A
considerable portion of the infant’s day is spent in caregiving
activities and the pattern of caregiving frequently involves
repetitive
interruption. In one of the earliest studies of neonatal
caregiving,
nursing interventions were the most frequent source of infant
contact, with an average of 1.68 interventions occurring per
hour.
16 The pattern of caregiving has been documented in
hospitalized preterm infants (mean gestational age 31.7 weeks)
using 24-hour video recording.17 In total, 70% of care occurred
in
clusters (three or more activities), 11% in paired occurrences
(two
activities), and 19% in single activities. The mean duration of
clustered care was 8.31 minutes while the mean duration of
single
care activities was 0.48 minutes. In another study of low-risk
preterm infants (31 to 36 weeks gestational age, postnatal age 3
to
16 days), caregiving was found to be the predominant factor,
producing cyclic influences based on pattern of caregiving.
18

12. Although caregiving procedures differ across nurseries, in
general
studies of care patterns have demonstrated significant amounts
of
disruption as well as changeable pattern of caregiving. Although
the thermal disruption produced by caregiving is clinically
recognized, there have been few studies of the effect of
caregiving
on infant and incubator and infant temperature.
The consequences of caregiving on temperature involve two
general areas of concern. The first concern is the direct effect of
caregiving on incubator and/or infant temperature. In preterm
infants less than 1500 g, decreases in both peripheral (sole of
foot,
mean 1.31C, range 0.2 to 3.0) and central (abdominal skin,
mean
0.71C, range 0.0 to 1.71C) temperature occurred with
caregiving
episodes that lasted 15 to 45 minutes; temperature recovery
required up to a 2-hour period.19 The decline in body
temperature
was negatively correlated with body weight. Using an
intervention
protocol to improve thermal environment stability in fragile
ELBW
infants (23 to 29 weeks gestational age) during the first days of
life,
one nurse investigator demonstrated less variability in ambient
temperature, less peripheral vasoconstriction (heel temperature
<35.21C), and decreased gradient between heel and abdominal
skin temperature.
20 In this experimental study, approximately 10 to
11 caregiving disruptions occurred in a 10-hour period.20

13. The second area of concern related to temperature effects of
caregiving is related to sensory stimulation. Although not
widely
studied in preterm infants, thermal stimulation is a powerful
form
of sensory input. In a study of temperature stimulation, heart
rate
variability was entrained by differing frequencies of skin (palm)
temperature; this entrainment varied with age.21 Thus, preterm
infants are sensitive to thermal stimulation and this stimulation
potentially affects multiple functions.
MATERIALS AND METHODS
Infant and incubator temperature were recorded continuously
over
a 24-hour period in 40 hospitalized preterm infants using an
intensive within-subject design. Selection criteria included:
gestational age 26 to 33 weeks and postnatal age 14 to
28 days, housed in an incubator, weight average for gestational
age, absence of major congenital anomalies and surgical
interventions, intraventricular hemorrhage rGrade II, and not
receiving phototherapy at the time of study. Infants receiving
>28
days of ventilatory assistance were excluded from the study.
Given the selection criteria, infants were medically stable,
experiencing the typical problems of prematurity. The study was
conducted in the NICU of a large Northwestern metropolitan
hospital in which average nursery ambient temperature
was 231C.
Infant abdominal skin and incubator temperature were recorded
at minute intervals using a battery-operated monitor (Vitalog
PMS8, Redwood, CA). A skin probe (YSI427, Yellow Springs,

14. OH)
was adhered to the infant’s right lateral abdomen, at the point of
intersection of perpendicular lines drawn from the anterior
axilla
and the umbilicus, using a reflective probe cover (Accutemp
Plus,
Kentec Medical, Irvine, CA) which was then covered with an air
and moisture permeable tape (Tegaderm, 3M, St. Paul, MN). An
ambient air temperature probe (YSI405, Yellow Springs, OH)
was
suspended 10 cm from the center of the incubator ceiling. The
recorded air temperatures reflected the central portion of the
incubator where the infant was positioned. Temperature probes
were calibrated against a certified thermometer to assess
accuracy
(r>o.99).
Infants were videotaped throughout the 24-hour data collection
period using a lapse time video recording system with 12:1
reduction (Panasonic AG-6030). A mini-camera (Toshiba) was
suspended from the incubator ceiling, providing a view of the
infant and incubator interior. Caregiving was defined as all
health-
related entrances to the incubator. Caregiving was coded from
the
videotapes in 1-minute epochs using a dichotomous code
(absent,
present). Type of caregiving was not recorded. Inter-rater
reliability
of coding, determined by percent agreement, was maintained at
>85%. The time stamp on the video recording was synchronized
with the computer used in programming the temperature
monitor;
the time difference between the two systems was <5 seconds
over a
24-hour period.

15. Care clusters were determined from the caregiving code and
care onset and offset were then determined. As caregiving was
coded yes/no and care of preterm infants often involves multiple
incubator entrances, a care cluster was operationally defined as
an
episode of care lasting at least 1 minute and preceded by an
interval of greater than 20 minutes without caregiving. This
definition was based on visual analysis of tapes as well as
consultation with neonatal nursing experts. Duration of care
clusters and the interval between clusters were calculated.
Infant
and incubator temperature at care onset, offset, and at 5, 10, 15,
and 20 minutes following care offset were then identified.
Differences in temperature from care onset to offset and the
time
following as well as the effect of incubator control mode were
Temperature and Caregiving Thomas
Journal of Perinatology 2003; 23:640 – 645 641
analyzed using analysis of variance for repeated measures
(ANOVA-RM).
Informed consent for participation was obtained from parents.
Following application of temperature recording and video
equipment, infants received typical nursery care. Selection of
incubator operation mode as well as set point for air servo- or
skin
servo-control was based on unit procedures and nurses’ clinical
judgment. Incubators were the same model (Air Shields C-200).
Study procedures were approved by human subjects review
committees at both the investigator’s home institution and the

16. study clinical setting.
RESULTS
Subject characteristics and temperature-descriptive statistics are
provided in Tables 1 and 2. Mean gestational age of the 40
subjects
was 30.3 (SD 2.5) weeks and mean postnatal age at time of
study
was 16.6 (SD 4.8) days. The sample distribution of race and
ethnicity was Black, 2; Hispanic, 3; Asian, 2; White, 33. The
description of caregiving clusters is provided in Table 3. Infants
received caregiving during 11 to 46% of the 24 hour recording
period, mean 23%. The mean number of clusters per 24 hours
was
12.6 and mean interval between care was 87.9 minutes. The
mean
duration of care clusters was 25.6 minutes; however, the
caregiving
mode was 1. For 16.7% of all care clusters, care duration was 1
minute, and care duration of 1 to 2 minutes accounted for 25%
of
all care clusters. Thus, there was considerable variability both
within and across subjects, with frequent very short-term care
as
well as long bouts of care.
There were no significant differences (t-test) between incubator
control mode in mean cluster duration or interval, number of
care
clusters, percent of time in caregiving, and Apgar scores at 1
and 5
minutes. There was no association (w2) between incubator
control
mode and gender, oxygen therapy, treatment of sepsis,
continuous

17. or intermittent gavage feeding, and receipt of antibiotics or
caffeine. No infants were receiving analgesics or propranalol.
Five
infants in skin servo-control incubators were receiving
lorazapam.
Infants in skin servo-control incubators differed from those in
air
servo-control (t-test, 38 df) by gestational age (28.12 vs 30.30
weeks, p ¼ 0.002), postconceptional age (30.18 vs 32.67 weeks,
p<0.000), and study weight (1060.53 vs 1545.17 g, p<0.000).
Using w2, there was an association between incubator control
mode
and IV therapy (skin, 13; air, 6, p ¼ 0.002) and ventilatory
support
(skin, 8; air, 4, p ¼ 0.053). Mean abdominal skin temperature
for
all subjects at onset of care cluster was 36.401C (SD 0.726) and
mean incubator air temperature was 30.721C (SD 2.45).
Changes
in temperature following caregiving were highly variable, with
increase and/or decrease in both infant and incubator
temperature
following care. Duration of care cluster did not correlate with
temperature changes following care (r<0.10). As the set points
for
incubator control differ based on type of control, control mode
was
examined in relationship to temperature changes in infant and
incubator following care (Table 4, Figure 1).
Table 1 Sample Characteristics by Incubator Control Mode
Variable Air servo-control
(n=23)

18. Skin servo-control
(n=17)
Total
(N=40)
fr (%) Fr (%) fr (%)
Gender
Male 15 (65.2) 8 (47.1) 23 (57.5)
Female 8 (34.8) 9 (52.9) 17 (42.5)
Oxygen 7 (30.4) 10 (58.8) 17 (42.5)
Ventilation* 4 (17.4) 8 (47.1) 12 (30)
IV fluids 6 (26.1) 13 (76.5) 19 (47.5)
IVH 1 (4.3) 2 (11.8) 3 (7.5)
Sepsis 5 (21.7) 6 (35.3) 11 (27.5)
Intermittent gavage 14 (60.9) 6 (35.3) 20 (50)
Continuous gavage 7 (30.4) 10 (58.8) 17 (42.5)
Nipple fed 6 (35.3) 0 6 (15)
Antibiotics 3 (13.0) 3 (17.6) 6 (15)
Bronchodilator 4 (17.4) 1 (5.9) 5 (12.5)

19. Caffeine 8 (34.8) 8 (47.1) 16 (40)
Lorazepam 0 5 (29.4) 5 (12.5)
Steriods 4 (17.4) 5 (29.4) 9 (22.5)
Note: IV=intravenous, IVH=intraventricular hemorrhage.
*
Ventilation includes continuous positive airway pressure.
Table 2 Descriptive statistics by incubator control mode
Air servo-control (n=23) Skin servo-control (n=17) Total
(N=40)
Variable Mean (SD) Min/Max Mean (SD) Min/Max Mean (SD)
Min/Max
Gestational age (weeks) 30.3 (2.5) 26/30 28.1 (1.6) 26/31 29.4
(2.4) 26/33
Birth weight (g) 1506.0 (409.1) 910/2220 1098.5 (237.2)
566/1500 1332.8 (398.9) 566/2220
Apgar 1 minute 5.6 (2.4) 2/9 4.7 (2.3) 1/9 5.2 (2.3) 1/9
Apgar 5 minute 7.3 (1.5) 4/9 7.3 (1.2) 5/9 7.3 (1.3) 4/9
PCA (weeks) 32.7 (2.1) 29.1/35.3 30.2 (1.4) 28.1/32.8 31.6
(2.2) 28.1/35.3
PNA (day) 16.6 (4.8) 13/29 14.5 (2.1) 11/18 15.7 (4.0) 11/29
Study weight (g) 1545.2 (414.5) 906/2300 1060.5 (220.1)
625/1390 1339.2 (419.1) 625/2300

20. Thomas Temperature and Caregiving
642 Journal of Perinatology 2003; 23:640 – 645
Infant and incubator temperature across time were analyzed
separately using ANOVA-RM (Table 5) and the Greenhouse –
Geisser epsilon correction for F test degrees of freedom. For
infant
temperature there was a significant time and time � control
main
effect. Within subject contrasts demonstrated significant
polynomial
time and time � control effects. ANOVA-RM for incubator
temperature also revealed significant main effects for time and
time � control with significant polynomial components for time
and time � control. Using t-test comparisons, abdominal
temperature at care onset did not differ between control modes,
although mean air temperature in skin servo-control was
slightly
higher than in air servo-control (36.44 vs 36.371C). In air
servo-
control incubators, mean infant temperature tended to decrease
during care, continued to decrease after care offset, and then
rose
slightly, however at 20 minutes following care offset precare
temperature was not re-established. In skin servo-control, mean
infant temperature tended to increase slightly throughout care
and after.
Summarizing infant temperature data using the mean does not
portray clinically significant changes occurring within infants.
Change in infant temperature following caregiving was further

21. examined in those infants whose abdominal skin temperature at
care onset was within normal ranged, defined as 36.2 to 36.81C.
Infant temperature at care onset was compared with temperature
at
20 minutes following care offset. In air servo-control
incubators, of
the 71 care clusters (representing 23 infants) that started with
infant temperature within normal range, temperature was below
normal range in 21 (30%) and above normal range in 14 (20%),
20 minutes following care offset. In skin servo-control
incubators,
there were 90 care clusters (representing 17 infants), initiated
while
infant temperature was within normal range, that resulted in
temperature below normal range in 10 instances (11%) and
above
Table 3 Description of Daily Caregiving (N=503 Care Clusters,
40 Infants)
Variable Mean SD Minimum Maximum
Clusters/infant 12.6 2.6 9 17
Cluster duration (min) 25.6 27.3 1 224
Cluster interval (min) 87.9 53.2 10 316
Caregiving (%) 23 8 11 46
Table 4 Effect of Caregiving on Infant and Incubator
Temperatures by Incubator Control Mode (N=40)
Air servo-control (n=23) Skin servo-control (n=17)

22. Infant Incubator Infant Incubator
Time T1C D T1C D T1C D T1C D
Onset
Mean (SD) 36.37 (0.77) 30.25 (1.60) 36.44 (0.67) 31.31 (3.14)
Min/max 33.63/38.25 27.10/33.50 33.17/38.75 22.51/37.25
Offset
Mean (SD) 36.29 (0.75) 0.08 (0.57) 30.37 (1.55) �0.11 (0.43)
36.46 (0.61) �0.02 (0.52) 31.76 (3.38) �0.45 (1.79)
Min/max 33.47/37.99 �1.89/2.72 27.10/34.24 �2.11/1.59
34.60/37.85 �2.62/2.47 22.73/38.57 �7.78/4.32
5 minutes
Mean (SD) 36.26 (0.76) 0.12 (0.59) 30.33 (1.57) �0.08 (0.39)
36.45 (0.65) �0.01 (0.52) 31.92 (3.55) �61 (2.01)
Min/max 34.17/37.99 �1.79/2.75 27.10/34.13 �1.54/1.50
34.04/37.85 �2.54/2.29 22.37/39.84 �8.75/4.70
10 minutes
Mean (SD) 36.26 (0.75) 0.12 (0.59) 30.27 (1.59) �0.02 (0.35)
36.46 (0.65) �0.03 (0.54) 31.99 (3.64) �0.70 (2.20)
Min/max 34.28/38.07 �1.79/1.96 27.10/33.60 �1.56/1.35
33.85/37.85 �2.75/2.35 22.23/40.35 �9.65/5.09
15 minutes
Mean (SD) 36.27 (0.77) 0.04 (0.61) 30.25 (1.60) 0.01 (0.33)
36.47 (0.63) �0.04 (0.56) 31.96 (3.70) �0.68 (2.34)
Min/max 34.17/38.17 �1.79/1.92 27.03/34.13 �1.46/1.29

23. 33.78/37.85 �2.94/2.50 22.80/40.49 �10.24/5.38
20 minutes
Mean (SD) 36.29 (0.77) 0.08 (0.62) 30.24 1.62 0.02 (0.35)
36.49 (0.63) �0.06 (0.56) 31.95 (3.64) �0.63 (2.40)
Min/max 33.97/38.17 �1.83/1.83 27.03/34.34 �2.38/1.43
33.89/37.82 �3.08/2.64 22.73/40.49 �10.47/5.66
Note: T1C=temperature; D=temperature difference: onset –
offset, and offset-value at 5, 10, 15, and 20 minutes,
respectively.
Positive value=temperature decrease after care, negative
value=temperature increases after care.
Temperature and Caregiving Thomas
Journal of Perinatology 2003; 23:640 – 645 643
normal range in 21 instances (23%). For those care clusters that
began when infants’ temperature was within normal range, the
minimum and maximum temperature change following care was
�1.07 to 1.711C in air servo-control mode and �1.35 to 0.961C
in
skin servo-control mode.
Incubator temperature differed between control mode at all time
points and skin servo-control demonstrated greater variability.
Air
servo-control incubators showed little change in air temperature
during care and following. In skin servo incubators, air
temperature increased with care giving and remained elevated
20
minutes following care offset.

24. Infants in servo-control were less than 33 weeks
postconceptional age. To examine the possible confounding of
postconceptional age and incubator control mode, the sample
was
divided into two subgroups, <33 and Z33 weeks
postconceptional
age and compared. There were no statistically significant
differences by age group in abdominal temperature at care onset
or
offset. Air temperatures were generally warmer in infants less
than
33 weeks PCA compared to those 33 weeks and older (31.19 vs
29.461C, p ¼ 0.018) and remained warmer after care offset.
Owing
to subject numbers and limited statistical power,
postconceptional
age could not be entered as a covariate in the ANOVA-RM
reported
above. A modified model, using only infants less than 33 weeks
(n ¼ 27) and comparing temperature at care onset, care offset,
and 15 and 20 minutes following care offset also demonstrated a
significant main effect of control (3, 23 df, p ¼ 0.048) and
significant within subject time � control effect.
DISCUSSION
The findings illustrate that caregiving is associated with
changes in
infant and incubator temperature and incubator control mode is
a
factor governing these changes. Synthesizing the results of five
research articles in which either (1) oxygen consumption was
used
to define TNZ, or (2) skin temperature was recorded when core

25. body temperature was carefully controlled within normal range,
abdominal skin temperature between 36.2 and 36.81C is used to
define TNZ.
22 – 26 While the magnitude of mean change in infant
temperature is relatively small, decreasing temperature
following
care in air servo-control incubators results in unacceptably low
temperatures in some infants. Caregiving resulted in significant
change in incubator temperature, with particularly large
variation
in skin servo-control incubators. The higher skin servo-control
air
temperatures following caregiving indicate the ambient
temperature required to sustain infant temperature following
this
disruption. Again, the mean values do not adequately portray
the
experiences of some infants with extremely large changes in
incubator temperature following caregiving. While the changes
in
incubator temperature support maintenance of infant
temperature,
they also reflect considerable thermal stimulation. The effect of
thermal stimulation in preterm infants is incompletely
understood;
however, temperature has been related to respiratory control.
27
Table 5 Analysis of Variance for Repeated Measures for Infant
and
Incubator Temperature at Care Onset, Offset, and 5, 10, 15, and
20

26. Minutes Following Offset (n=40)
Source F df p
Infant
Multivariate test Time 3.483 5, 34 0.012
Time � control 3.012 5, 34 0.023
Within subjects contrast Time 11.092 1, 38 0.002
Time � control 9.039 1, 38 0.005
Incubator
Multivariate test Time 7.903 5, 34 0.000
Time � control 7.792 5, 34 0.000
Within subjects contrast Time 13.863 1, 38 0.001
Time � control 25.927 1, 38 0.000
Incubator Control Method
Skin servoAir servo
In
cu
b
a
to
r
°C

27. 33.0
32.5
32.0
31.5
31.0
30.5
30.0
29.5
onset
offset
5 min after offset
10 min after offset
15 min after offset
20 min after offset
Incubator Control Method
Skin servoAir servo
In
fa
n

28. t
°C
36.7
36.6
36.5
36.4
36.3
36.2
36.1
onset
offset
5 min after offset
10 min after offset
15 min after offset
20 min after offset
Figure 1. Incubator and infant temperature following caregiving
(95% confidence intervals).
Thomas Temperature and Caregiving
644 Journal of Perinatology 2003; 23:640 – 645

29. In a previous study, differing thermal environments were
produced by skin and air servo-incubator control modes.6 Skin
servo-control resulted in more variable air but more stable
infant
temperature, while air servo-control resulted in more stable air
and
more variable infant temperature.6 In a Cochrane review of
incubator control mode, skin servo-control reduced neonatal
death
rate among low-birth-weight infants, particularly among VLBW
(relative risk 0.72, 95% CI 0.54 to 0.97).28 The current study
shows
that the thermal effects of caregiving also differ by incubator
control mode. The study was not designed to determine
superiority
of incubator control mode. Rather, results highlight the need for
further study of incubator control.
Videotaping may have influenced caregiving pattern and hence
the thermal responses observed. Only the hands of caregivers
were
visible and caregivers were not identifiable. The camera was
unobtrusive and did not physically interfere with the infants
care.
Nursery staff were accepting the research study and did not
express
discomfort with the videotaping procedures.
In summary, preterm infant caregiving activities altered both
infant and incubator temperature. These changes in temperature
were dependent on mode of incubator control. In general, air
servo-control resulted in reduction of mean infant temperature
with caregiving, while in skin servo-control mean infant

30. temperature tended to rise with caregiving. Within infants,
however, caregiving produced variable effects, with body
temperature both increasing and decreasing following
caregiving.
Incubator regulation in response to caregiving produces wide
variability in air temperature. Further investigation of the effect
of
this thermal stimulation is needed.
References
1. Narendran V, Hoath SB. Thermal management of the low
birth weight
infant: a cornerstone of neonatology. J Pediatr 1999;134(5):529
– 31.
2. Apedoh A, el Hajajji A, Telliez F, Bouferrache B, Libert JP,
Rachid A.
Mannequin-assessed dry-heat exchanges in the incubator-nursed
newborn.
Biomed Instrum Technol 1999;33(5):446 – 54.
3. Graven SN, Bowen FW, Brooten D, et al. The high-risk infant
environment.
Part 1. The role of the neonatal intensive care unit in the
outcome of high-
risk infants. J Perinatol 1992;12(2):164 – 72.
4. Dollberg S, Demarini S, Donovan EF, Hoath SB. Maturation
of thermal
capabilities in preterm infants. Am J Perinatol 2000;17(1):47 –

31. 51.
5. Richardson DK, Shah BL, Frantz ID, Bednarek F, Rubin LP,
McCormick
MC. Perinatal risk and severity of illness in newborns at 6
neonatal
intensive care units. Am J Med Sci 1999;89(4):511 – 6.
6. Thomas KA, Burr R. Preterm infant thermal care: differing
thermal
environments produced by air versus skin servo-control
incubators.
J Perinatol 1999;19(4):264 – 70.
7. Dollberg S, Atherton HD, Hoath SB. Effect of different
phototherapy lights on
incubator characterisitcs and dynamics under three modes of
servocontrol.
Am J Perinatol 1995;12(1):55 – 60.
8. Bach V, Telliez F, Zoccoli G, Lenzi P, Leke A, Libert JP.
Interindividual
differences in the thermoregulatory response to cool exposure in
sleeping
neonates. Eur J Appl Physiol 2000;81(6):455 – 62.
9. Omar SY, Greisen G, Ibrahim MM, Youssef AM, Friis-
Hansen B. Blood

32. pressure reponses to care procedures in ventilated preterm
infants. Acta
Pædiatr Scand 1985;74:920 – 4.
10. Brandon DH, Holditch-Davis D, Beylea M. Nursing care and
the
development of sleeping and waking behaviors in preterm
infants. Res
Nurs Health 1999;22(3):217 – 29.
11. Evans JC. Incidence of hypoxemia associated with
caregiving in premature
infants. Neonatal Netw 1991;10(2):17 – 24.
12. Evans JC, Vogelpohl DG, Bourguignon CM, Morcott CS.
Pain behaviors in
LBW infants accompany some ‘‘nonpainful’’ caregiving
procedures.
Neonatal Netw 1997;16(3):33 – 40.
13. Gorski PA, Huntington L, Lewkowicz DJ. Handling preterm
infants in
hospitals. Stimulating controversy about timing of stimulation.
Clin
Perinatol 1990;17(1):103 – 12.
14. Ingersoll EW, Thoman EB. Sleep/wake states of preterm

33. infants: stability,
developmental change, diurnal variation, and relation with
caregiving
activity. Child Dev 1999;70(1):1 – 10.
15. Zahr LK, Balian S. Responses of premature infants to
routine nursing
interventions and noise in the NICU. Nurs Res 1995;44(3):179 –
85.
16. Duxbury ML, Henly SJ, Broz LJ, Armstrong GD, Wachdorf
CM. Caregiver
disruptions and sleep of high-risk infants. Heart Lung 1984;
13:141 – 7.
17. Evans JC. Patterns of caregiving for premature infants.
Neonatal Netw
1992;11(1):62.
18. Bueno C, Diambra L, Menna-Barreto L. Sleep – wake and
temperature
rhythms in preterm babies maintained in a neonatal care unit.
Sleep Res
Online 2001;4(3):77 – 82.
19. Mok Q, Bass CA, Ducker DA, McIntosh N. Temperature
instability during
nursing procedures in preterm neonates. Arch Dis Child

34. 1991;66:783 – 6.
20. Horns KM. Comparison of two microenvironments and
nurse caregiving on
thermal stability of ELBW infants. Adv Neonatal Care
2002;2(3):149 – 60.
21. Shefi O, Davidson S, Maayan A, Akselrod S. The effect of
thermal
stimulation on the heart-rate variability in neonates. Early Hum
Dev
1998;52(1):49 – 66.
22. Bach V, Telliez F, Zoccoli G, Lenzi P, Leke A, Libert JP.
Interindividual
differences in the thermoregulatory response to cool exposure in
sleeping
neonates. Eur J Appl Physiol 2000;81(6):455 – 62.
23. Mayfield SR, Bhatia J, Nakamura KT, Rios GR, Bell EF.
Temperature
measurement in term and preterm neonates. J Pediatr 1984;
104(2):271 – 5.
24. Bell EF, Rios GR. Air versus skin temperature servocontrol
of infant
incubators. J Pediatr 1983;103(6):954 – 9.
25. Sjors G, Hammarlund K, Kjartansson S, Riesenfeld T, Sedin

35. G. Respiratory
water loss and oxygen consumption in full-term infants exposed
to cold air
on the first day after birth. Acta Pædiatr 1994;83(8):802 – 7.
26. Telliez F, Bach V, Delanaud S, Leke A, Abdiche M,
Chardon K. Influence of
incubator humidity on sleep and behaviour of neonates kept at
stable body
temperature. Acta Pædiatr 2001;90(9):998 – 1003.
27. Berterottiere D, D’Allest AM, Dehan M, Gaultier C. Effects
of increase in body
temperature on the breathing pattern in premature infants. J Dev
Physiol
1990;13(6):303 – 8.
28. Sinclair JC. Servo-control for maintaining abdominal skin
temperature at
361C in low birth weight infants. Cochrane Database Syst Rev
2000;
(2):CD001074.
Temperature and Caregiving Thomas
Journal of Perinatology 2003; 23:640 – 645 645

36. STA 614 Cumulative Assessment #3 - FINAL (Fall 2015)
The final cumulative assignment is comprised of 21 short-
answer questions posted on Blackboard and is worth 225 points.
For some of the questions you will need refer to posted articles
and for others you may need to use StatCrunch (these things are
indicated clearly in bold/underlined text either within questions
or prior to a group of questions, so please read carefully!). You
may copy tables directly from StatCrunch into the Blackboard
answer box as needed, however it is preferred that you would
simply incorporate only those numbers that are absolutely
necessary into your written response. Note that there is no
formal StatCrunch report for this assignment.
Please put all of your answers into Blackboard and submit your
final assignment as soon as you can get it done. While the
official deadline is Friday December 11, we would like to be
able to grade assignments as they are completed throughout the
week since final course grades are due on December 14. Please
note that this assignment covers all aspects of the course with a
slight focus toward the last four weeks.Also note: if you need
your grade submitted to SAP so that you can print paperwork to
meet a reimbursement deadline, please send me an email
immediately after submitting your final with a request for
expedited grading.
Collaboration Policy and Grading
Collaboration Policy (Please please please do not do anything
that would force me to apply this!!!)
Absolutely no collaboration or communication of any kind with
other students or friends to aid in the completion of these
assignments is allowed. This includes, but is not limited to,
verbal or email communication, text messaging, etc. If for any
reason I deem that you have violated this policy, then you will
at minimum receive a 0 for the assignment and most likely a
failing grade in the course.
Please note: It is acceptable to email Dr. Nolan for

37. clarifications related to the CUA – but please don’t expect
answers to questions of a statistical nature about specific parts
of this assignment. It is also important to remember that you
may and should feel free to ask of me any general questions or
questions about other assignments/feedback from the course and
I will gladly answer those.
Please please please do not do anything that would cause me to
need to enforce this policy! Thanks!
Grading Rubric: Answers will receive…
Full Credit: Question is answered completely and correctly
80-95% Credit: Answer contains 1-2 minor statistical errors
60-80% Credit: Answer contains 3+ minor statistical errors or
any major statistical error
0-60% Credit: Answer is substantially incomplete, contains
multiple major statistical errors, or does not address the
question that was asked.
Reminder: Expected answer lengths are given for many

38. questions and reflect roughly the length of answers in my
solution key. Please note that the expected length of answer
will have nothing to do with the grading – however it is also
true that the inclusion of irrelevant information (especially if it
is incorrect) may result in deductions.
Questions 1-6 refer to Article 1, entitled Preterm Infant Thermal
Responses to Caregiving Differ by Incubator Control Mode,
found in the final cumulative assessment folder on Blackboard.
#1 (25 points) In Table 2, they provide means and standard
deviations for birth weight for the two samples (air/skin). First
explain why the two samples are independent. Then use
StatCrunch to conduct an appropriate test to determine if the
mean birth weights differ between the two groups. Indicate
validity conditions for the test and assess whether they are
satisfied. Then give the appropriate output from StatCrunch
and a sentence describing the results of the test. Also produce
and interpret a confidence interval in an appropriate manner.
Finally, indicate how this all might impact the authors analysis.
(Expected length of answer: SC Output + 150-250 words)
Hint: To conduct this test you should provide StatCrunch with
“summary statistics”. You should not need to put anything into
the data table.
#2 (12 points) In Table 5 a repeated measures, two-way
ANOVA is conducted. Explain WHY repeated measures is
appropriate in this case. Then identify the four factors involved
in the study and their levels. (Expected length of answer: 100-
200 words)
#3 (12 points) The means given in Table 4 can be placed into
the interaction plot shown below. Assuming that the larger
differences in means that are observed in this plot are in fact
significant, carefully interpret the information contained in the
plot. In particular, what are the most important effects? The
interaction effect tested significant in Table 5. What does the

39. plot tell you about its importance? (Expected length of answer:
100-200 words) Note: The vertical axis is temperature on the
Celsius scale. **Uses Article 2 I-plot.jpg**
#4 (12 points) In the discussion on page 643, the authors state:
“Using t-test comparisons, abdominal temperature at care onset
did not differ between control modes, although the mean air
temperature in skin servo-control was slightly higher than in air
servo-control (36.44 vs 36.37°C).” What three serious
statistical mistakes have the authors committed in making this
conclusion? (Expected Length of Answer: 50-100 words)
#5 (10 points) Based on the discussion section, identify two
specific limitations of this study. Describe how a future study
might avoid these limitations. (Expected Length of Answer:
100-200 words)
#6 (10 points) In a follow-up study, you wish to determine
whether Apgar scores can predict the need for incubation.
Write a brief introduction to a report in which you will analyze
these. Make sure to include the statistical method you will use
and any appropriate references.
Questions 7-11 refer to Article 2, entitled Association between
heart rate variability and manual pulse rate, found in the final
cumulative assessment folder on Blackboard.
#7 (10 points) The authors state in the caption of Table 2 (page
248) that they’ve used Pearson correlation for the first three
items and Spearman correlation for Age and BMI. Based on all
of the information they provide, do you agree with these
choices? What additional items (that were not provided) should
be reviewed to support these decisions? (Expected Length of
Answer: 50-150 words)
#8 (10 points) Table 2 in a somewhat unusual manner provides
95% CI’s for the correlation. Consider the first line relating to

40. the correlation between SDNN and Mean HR in HRV. Interpret
the CI (or if you prefer, the squares). (Expected Length of
Answer: 50-100 words)
#9 (10 points) On page 248 alone, the authors have reported no
less than twenty p-values and CI’s. How should this fact affect
their analysis? (Expected Length of Answer: <50 words)
#10 (12 points) In their analysis, the authors examined pairwise
correlations and used simple linear regression. They likely
should be using multiple regression. Explain how multiple
regression might be used here and briefly discuss additional
issues that might result from its use. Also indicate how such
issues may have already affected their use of correlation and
SLR. (Expected Length of Answer 50-100 words).
#11 (10 points) Near the end of page 248, the authors produced
a 95% CI for the slope related to Pulse1 (0.80 to 1.00) in a
model to estimate Mean HR in HRV as the dependent variable.
Give the statistical interpretation of this interval. (Expected
Length of Answer: <50 words)
Questions 12-15 refer to the StatCrunch dataset: 1601 Blood
Gas Values
The goal based on these 150 observations is to predict arterial
blood gas values (ABG, mm Hg) based on central venous blood
gas values (VBG, mm Hg). You should use StatCrunch in
coming up with your answers to these questions.
#12 (10 points) Assume that a regression is appropriate. Use
StatCrunch to provide the estimate of R2 for the regression
relationship and explain what the value means. (Expected
length of answer: <25 words)
#13 (10 points) Assume that regression is appropriate. Obtain
and interpret a 95% confidence interval for the slope. (Expected
length of answer: <50 words words)

41. #14 (10 points) Assume that regression is appropriate. Use
StatCrunch to predict with 90% confidence the ABG for a
patient having VBG = 40 mg Hg. Provide a proper statistical
statement from your prediction and then assess its clinical
value. (Expected length of answer: 50-75 words)
#15 (10 points) Assess all assumptions of the regression model
as best you can based on the data provided. If you use a graphic
for your assessment, do not attempt to copy that graphic into
Blackboard, but rather simply refer to it. (Expected length of
answer: 50-75 words)
Questions 16-21 are unrelated to any particular article or
dataset.
#16 (8 points) Elisabeth wishes to compare average heights
across three different groups of people. She plans to collect
data for 30 people chosen from each group. Provide Elisabeth
with a brief indication of what procedures she ought to use in
her analysis. (expected length of answer: <25 words)
#17 (9 points) Explain why the following statement is false:
When we lack evidence against our null hypothesis, this in
general means that we should collect a larger sample in order to
find such evidence (expected length of answer: 25-50 words).
#18 (9 points) The primary purpose of a manuscript I am
reading is to present lots and lots of different correlations. Will
I be able to make clinical use of the results? Why or why not?
(expected length of answer: 25-50 words)
#19 (9 points) Which are more valuable in assessing the clinical
importance of results: hypothesis testing or confidence
intervals? Explain your answer. (expected length of answer:
25-50 words)
#20 (9 points) An author uses two-factor ANOVA to examine
height as the response. He finds that there is an interaction

42. between his two factors, gender and ethnicity. Explain, in basic
terms, what it means to have such an interaction. You may use
examples as appropriate (expected length of answer: 25-50
words).
#21 (8 points) A study is submitted for IRB approval that plans
to compare the efficacy of a new drug, when used in addition to
current standards of care, in treating a particular form of cancer.
The study will be placebo-controlled, and investigators will
follow subjects until their deaths or until they choose to
withdraw from the study. Identify the appropriate response
variable and explain what analysis techniques might be used in
this scenario. (expected length of answer: 25-75 words)