Managing psychological distress is a central treatment goal in Pediatric Intensive Care Units (PICUs), with medical and psychological implications. However, there is no objective measure for assessing efficacy of pharmacologic and psychological interventions used to reduce distress. Development of the COMFORT scale is described, a nonintrusive measure for assessing distress in PICU patients. Eight dimensions were selected based upon a literature review and survey of PICU nurses. Interrater agreement and internal consistency were high. Criterion validity, assessed by comparison with concurrent global ratings of PICU nurses, was also high. Principal components analysis revealed 2 correlated factors, behavioral and physiologic, accounting for 84% of variance. An ecological-developmental model is presented for further study of children's distress and coping in the PICU.

We studied avian biogeography and habitat selection in forests of southern Wisconsin ranging in area from 3 to > 500 ha. Bird diversity in these woodlots increases with area, due primarily to an increase in the number of forest—dwelling, long—distance migrants. We consider two possible explanations for this pattern: (1) area—dependent changes in forest vegetation, or (2) area—dependent change in interactions with competitors, predators, or brood parasites. We first describe vegetation structure and composition, then show that this description comprises important habitat features of forest birds. Bird habitat is characterized in three ways: (1) vegetational structure within bird territories is compared with that at random locations in the same woodlots, (2) structural characteristics of territories of different species are compared, and (3) factors related to species' abundance in different woodlots are analyzed. We found no area—dependent trends in vegetation structure or composition that seem likely to influence the bird community. However, forest—edge and farmland species increase in density as woodlot area decreases. We suggest that forest—edge and farmland species exclude certain forest—dwelling, long—distance migrants from small woodlots, and that this exclusion influences the bird community more than area—dependent changes in habitat or the degree of woodlot isolation.

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