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Selected Abstracts"Destiny Has Thrown the Negro and the Filipino Under the Tutelage of America": Race and Curriculum in the Age of EmpireCURRICULUM INQUIRY, Issue 4 2009ROLAND SINTOS COLOMA ABSTRACT The article brings together the fields of curriculum studies, history of education, and ethnic studies to chart a transnational history of race, empire, and curriculum. Drawing from a larger study on the history of education in the Philippines under U.S. rule in the early 1900s, it argues that race played a pivotal role in the discursive construction of Filipino/as and that the schooling for African Americans in the U.S. South served as the prevailing template for colonial pedagogy in the archipelago. It employs Michel Foucault's concept of archaeology to trace the racial grammar in popular and official representations, especially in the depiction of colonized Filipino/as as racially Black, and to illustrate its material effects on educational policy and curriculum. The tension between academic and manual-industrial instruction became a site of convergence for Filipino/as and African Americans, with decided implications for the lived trajectories in stratified racialized and colonized communities. [source] A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depressionDEPRESSION AND ANXIETY, Issue 3 2002Adam B. Burrows M.D. Abstract Depression is common across a broad spectrum of severity among nursing home residents. Previous research has demonstrated the effectiveness of antidepressants in nursing home residents with major depression, but it is not known whether antidepressants are helpful in residents with less severe forms of depression. We conducted a randomized double-blind placebo-controlled 8-week trial comparing paroxetine and placebo in very old nursing home residents with non-major depression. The main outcome measure was the primary nurse's Clinical Impression of Change (CGI-C). Additional outcome measures were improvement on the interview-derived Hamilton Depression Rating Scale (HDRS) and Cornell Scale for Depression (CS) scores. Twenty-four subjects with a mean age of 87.9 were enrolled and twenty subjects completed the trial. Placebo response was high, and when all subjects were considered, there were no differences in improvement between the paroxetine and placebo groups. Two subjects that received paroxetine developed delirium, and subjects that received paroxetine were more likely to experience a decrease in Mini Mental State Exam scores (P = .03). There were no differences in serum anticholinergic activity between groups. In a subgroup analysis of 15 subjects with higher baseline HDRS and CS scores, there was a trend toward greater improvement in the paroxetine group in an outcome measure that combined the CGI-C and interview-based measures (P = .06). Paroxetine is not clearly superior to placebo in this small study of very old nursing home residents with non-major depression, and there is a risk of adverse cognitive effects. Because of the high placebo response and the trend towards improvement in the more severely ill patients, it is possible that a larger study would have demonstrated a significant therapeutic effect for paroxetine as compared with placebo. The study also illustrates the discordance between patient and caregiver ratings, and the difficulties in studying very elderly patients with mood disorders. Depression and Anxiety 15:102,110, 2002. © 2002 Wiley-Liss, Inc. [source] The relation between different dimensions of alcohol consumption and burden of disease: an overviewADDICTION, Issue 5 2010Jürgen Rehm ABSTRACT Aims As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. Methods Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. Results Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose,response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. Conclusions Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol,disease relationships. [source] Toxicity of brominated volatile organics to freshwater biotaENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 9 2010Monique T. Binet Abstract As part of a larger study investigating the fate and effects of brominated volatile organic compounds (VOCs) in contaminated groundwaters discharging to surface waters, the toxicity of 1,2 dibromoethene (DBE) and 1,1,2-tribromoethene (TriBE) to freshwater aquatic biota was investigated. Their toxicity to bacteria (Microtox®), microalgae (Chlorella sp.), cladocerans (Ceriodaphnia dubia), duckweed (Lemna sp.) and midges (Chironomus tepperi) was determined after careful optimization of the test conditions to minimize chemical losses throughout the tests. In addition, concentrations of DBE and TriBE were carefully monitored throughout the bioassays to ensure accurate calculation of toxicity values. 1,2-Dibromoethene showed low toxicity to most species, with concentrations to cause 50% lethality or effect (LC/EC50 values) ranging from 28 to 420,mg/L, 10% lethality or effect (LC/EC10 values) ranging from 18 to 94,mg/L and no-observed-effect concentrations (NOECs) ranging from 22 to 82,mg/L. 1,1,2-Tribromoethene was more toxic than DBE, with LC/EC50 values of 2.4 to 18,mg/L, LC/EC10 values of 0.94 to 11,mg/L and NOECs of 0.29 to 13,mg/L. Using these limited data, together with data from the only other published study on TriBE, moderate-reliability water quality guidelines (WQGs) were estimated from species sensitivity distributions. The proposed guideline trigger values for 95% species protection with 50% confidence were 2,mg/L for DBE and 0.03,mg/L for TriBE. The maximum concentrations of DBE and TriBE in nearby surface waters (3 and 1,µg /L, respectively) were well below these WQGs, so the risk to the freshwater environment receiving contaminated groundwater inflows was considered to be low, with hazard quotients <1 for both VOCs. Environ. Toxicol. Chem. 2010;29:1984,1993. © 2010 SETAC [source] Dietary accumulation, disposition, and metabolism of technical pentabrominated diphenyl ether (DE-71) in pregnant mink (Mustela vison) and their offspring,ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 5 2008Si Zhang Abstract Concentrations of polybrominated diphenyl ethers (PBDEs) in humans and wildlife suggest significant bioaccumulation potential in mammals, but no quantitative biomagnification data from controlled experiments are currently available. As part of a larger study examining the effects of PBDEs on mink (Mustela vison) reproduction and development, we examined congener-specific tissue distribution, maternal transfer, biotransformation, and biomagnification of the technical penta-BDE mixture, DE-71, in farmed mink. Adult female mink were fed one of four concentrations of DE-71 (0-2.5 ,g/g) in the diet from breeding through gestation and until weaning at 6 weeks postparturition. Parent PBDEs were measured in tissues and excreta of adult mink, kits, and juveniles, whereas hydroxylated PBDEs (OH-PBDEs) were measured in juveniles only. Similar lipid-normalized concentrations of PBDEs were detected in most tissues of adult mink with the exception of brain, in which concentrations were significantly lower. Kits, however, had a higher proportion of PBDEs in brain compared with adults, presumably because of incomplete development of the blood-brain barrier. Maternal transfer favored lower-brominated PBDE congeners, and the bulk of the body burden in kits at weaning resulted from lactational rather than transplacental transfer. Lipid-normalized, whole-body biomagnification factors ranged from 0.5 to 5.2 for the major congeners and were highest for BDEs 47 and 153. Metabolism clearly limited the biomagnification of some PBDEs, and OH-PBDEs were detectable in plasma, liver, and feces. On a mass basis, OH-PBDEs accounted for 28 to 32% of the excreted fraction, indicating metabolism was an important elimination pathway. Further studies are required to understand the mechanisms of PBDE biotransformation. [source] Effectiveness of a smoking cessation intervention in older adultsADDICTION, Issue 1 2007Robert J. Tait ABSTRACT Aims To: (a) identify characteristics of older smokers considering cessation of smoking; (b) evaluate a cessation intervention plus access to nicotine replacement therapy (NRT); (c) identify predictors of those who successfully quit; and (d) evaluate the effectiveness of the intervention in those aged , 75 years. Design Self-selection of: (a) a cessation of smoking programme; or (b) ongoing smoking. Setting Teaching hospital, Perth, Western Australia. Participants A larger study recruited smokers and never smokers: from this the 215 community-dwelling smokers (, 5 cigarettes/day) aged , 68 years (171 males) were enrolled. Intervention Brief intervention with telephone support and access to NRT versus no intervention. Measurements (a) Profile of older adults planning to quit smoking compared with continuing smokers; (b) cessation at 6 months defined as 30-day point prevalence validated via expired carbon monoxide; and (c) factors predictive of successful cessation. Findings There were 165 intervention participants. Compared with the 50 continuing smokers, participants in the intervention were younger and had significantly less years of regular smoking, more previous quit attempts and greater nicotine dependence scores. At 6 months, the point prevalence of ex-smokers was 25% (n = 42) with 20% (n = 33) being abstinent throughout the study. No continuing smoker had ceased smoking. Among the intervention group, logistic regression showed that those who used NRT (OR 4.36), were male (OR 3.17), had higher anxiety (OR 1.67) or rejected ,more colds and coughs' as a reason for quitting (OR 2.91) were more likely to be successful quitters. Of those aged , 75 years (n = 77), 25% matched cessation criteria. Conclusions Older smokers can be engaged successfully in a brief intervention plus NRT as aids to cessation of smoking. The intervention was also effective in the older subgroup of participants. Social factors may provide an additional means of motivating older smokers to quit. [source] Health-related Quality of Life of People with Epilepsy Compared with a General Reference Population: A Tunisian StudyEPILEPSIA, Issue 7 2004Hela Mrabet Summary:,Purpose: The goal of the study was to assess the health-related quality of life (HRQOL) of persons with epilepsy (PWE) by using the short form survey 36 (SF-36), to compare it with that of a control group and to detect factors influencing it. Methods: We collected clinical and demographic data and information on health status by using the Arabic translation of the SF-36 questionnaire from two groups: (a) 120 PWE consulting our outpatient clinic during a period of 4 months, and (b) 110 Tunisian citizens, representative of the Tunisian general population, as a control group. Results: The mean age of PWE group was 32.74 years, and 45.5% were men. Idiopathic generalized epilepsies were observed in 44.5% of cases, and symptomatic partial epilepsies, in 30%. The most commonly prescribed drug was sodium valproate (VPA). For the SF-36, PWE had lower scores than the control group for only three subscales: general health perception, mental health, and social functioning. Seizure frequency, time since last seizure, and the antiepileptic drug (AED) side effects were the most important variables influencing the HRQOL among PWE. Seizure-free adults have HRQOL levels comparable to those of the control group. Sociodemographic variables had no influence on the SF-36 subscales. Conclusions: HRQOL is impaired in Tunisian PWE. The influencing factors identified in this study differ from the previously published data. Several possible reasons such as family support and cultural and religious beliefs are proposed to explain these cross-cultural differences. A larger study should be conducted to verify such findings. [source] The impact of a motivational assessment interview on initial response to treatment in adolescent anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 2 2004S. G. Gowers Abstract This study was a pilot for a larger study to evaluate a time-limited outpatient programme for adolescent anorexia nervosa, to explore the ability of an assessment interview to change self-reported motivation and ascertain the extent to which this predicted engagement with treatment and early behavioural change. Forty-two adolescents with anorexia nervosa rated their motivation for change before and after attending a new-style assessment interview. Initial (6 week) effectiveness of the programme was evaluated by measuring engagement with treatment, weight change, clinician (HoNOSCA) and self-rated (EDI, MFQ, HoNOSCA-SR) outcome measures, overall and in relation to motivational status. The assessment interview significantly improved motivation. Motivational category after interview was unrelated to physical status, cognition or general functioning but predicted engagement with treatment. Whilst for the whole sample, treatment produced physical, cognitive and general improvements at 6 weeks, motivational status was a powerful predictor of weight gain. A client-centred assessment interview engaged 80% in an outpatient programme based on CBT. Motivational enhancement may improve engagement and specifically result in behavioural change and early weight gain. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Effect of Ethnicity on Denial of Authorization for Emergency Department Care by Managed Care GatekeepersACADEMIC EMERGENCY MEDICINE, Issue 3 2001Robert A. Lowe MD Abstract. Objective: After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital. Methods: A retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO. Results: African Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94). Conclusions: African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area. [source] ,I'm Home for the Kids': Contradictory Implications for Work,Life Balance of Teleworking MothersGENDER, WORK & ORGANISATION, Issue 5 2008Margo Hilbrecht This study explores the experience of time flexibility and its relationship to work,life balance among married female teleworkers with school-aged children. Drawing from a larger study of teleworkers from a Canadian financial corporation, 18 mothers employed in professional positions discussed work, leisure and their perceptions of work,life balance in in-depth interviews. Telework was viewed positively because flexible scheduling facilitated optimal time management. A key factor was the pervasiveness of caregiving, which could result in ongoing tensions and contradictions between the ethic of care and their employment responsibilities. The ideology of ,intensive mothering' meant that work schedules were closely tied to the rhythms of children's school and leisure activities. The different temporal demands of motherhood and employment resulted in little opportunity for personal leisure. Time ,saved' from not having to commute to an office was reallocated to caregiving, housework or paid employment rather than to time for their self. The women also experienced a traditional gendered division of household labour and viewed telework as a helpful tool for combining their dual roles. Time flexibility enhanced their sense of balancing work and life and their perceived quality of life. At the same time, they did not question whether having the primary responsibility for caregiving while engaged in paid employment at home was fair or whether it was a form of exploitation. [source] Staying with People Who Slap Us Around: Gender, Juggling Responsibilities and Violence in Paid (and Unpaid) Care WorkGENDER, WORK & ORGANISATION, Issue 2 2006Donna BainesArticle first published online: 13 FEB 200 Little is actually known about women's occupational health, let alone how men and women may experience similar jobs and health risks differently. Drawing on data from a larger study of social service workers, this article examines four areas where gender is pivotal to the new ways of organizing caring labour, including the expansion of unpaid work and the use of personal resources to subsidize agency resources; gender-neutral violence; gender-specific violence and the juggling of home and work responsibilities. Collective assumptions and expectations about how men and women should perform care work result in men's partial insulation from the more intense forms of exploitation, stress and violence. This article looks at health risks, not merely as compensable occupational health concerns, but as avoidable products of forms of work organization that draw on notions of the endlessly stretchable capacity of women to provide care work in any context, including a context of violence. Indeed, the logic of women's elastic caring appear crucial to the survival of some agencies and the gender order in these workplaces. [source] ,My biggest fear was that people would reject me once they knew my status,': stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South AfricaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2010Leah Gilbert BA MPH PhD Abstract Stigma is not a new concept; however, it remains highly significant in the context of HIV/AIDS in South Africa. There is wide consensus that HIV/AIDS-related stigma compromises the well-being of people living with the disease. This paper is part of a larger study that seeks to understand the social and cultural complexity related to the provision and outcomes of antiretroviral therapy (ART) in South Africa. It explores and analyses how patients on ART perceived and experienced stigma and how it has shaped their behaviour towards, as well as their understanding of the epidemic. The data have been collected by means of in-depth face-to-face interviews, conducted between June and November 2007, with a sample of 44 patients in an HIV/AIDS clinic in a resource-limited setting in Johannesburg, South Africa. The findings reveal that the level of felt and anticipated stigma is intense and affects all dimensions of living with HIV/AIDS, particularly disclosure and treatment. Stigma permeates the experience of HIV-positive people on ART who participated in this study. The intensity of HIV/AIDS-related stigma can threaten to compromise the value of ART, thus impacting on the daily lives of people living with HIV/AIDS (PLWHA). This study suggests that three decades into the epidemic, stigmatisation remains a core feature of the patient experience of HIV/AIDS. In the clinic in which this research was conducted, HIV/AIDS was regarded as a chronic condition increasingly manageable by ongoing access to ART. However, this approach was not shared by many family members, neighbours and employers who held highly stigmatised views. [source] What is the perceived nature of parental care and support for young people with cystic fibrosis as they enter adult health services?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010Nicola Iles RN MSc Abstract The majority of those diagnosed with cystic fibrosis (CF) now live to adulthood. In response to increased survival age, transition services have been developed to ensure smooth transfer from paediatric to adult specialist healthcare, although the majority of treatment and care continues to be delivered in the home. However, little is known about how young adults and staff conceptualise the nature of the parental role after young people have left paediatric care. The aim of this study is to explore the nature of parental support that is perceived to be available at this time. As part of a larger study of transitional care, semi-structured interviews were conducted with 50 young people with CF aged 13,24 years (32 with experience of transition and/or adult CF services) and 23 specialist healthcare professionals (14 working in adult care) across two CF centres in Southeast England. Interviews took place in young people's homes or within CF services, using a topic guide and were recorded, transcribed and analysed thematically. Four domains of perceived parental support were identified by the young people interviewed, with varying degrees of continuity into adult care: (1) Providing non-clinical practical and emotional support; (2) Acting as ,troubleshooters' in times of health-related crisis; (3) Working in partnership with offspring in ongoing disease management in the home and clinic; (4) Acting as ,protectors' of their children. Young people and service staff expressed tensions in managing parental involvement in post-paediatric consultations and the degree to which parents should be aware of their offspring's deteriorating health and social concerns. Parental anxiety and over-involvement was perceived by many young people and staff as unsupportive. We suggest that although health and social care providers are mindful of the tensions that arise for those leaving paediatric services, the place of parental support in adult care is currently contentious for these ,new' ageing populations. [source] Informal care: the views of people receiving careHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2002S. McCann BA MPsychSc Abstract Informal care is perceived to be the best option for people who require assistance to look after themselves. National and international studies of informal care have focused on the carer, not on the care provided, or the needs and experiences of the care recipients. In the present study, 55 people receiving informal care (21 males and 24 females, mean age = 67.6) were surveyed to determine the type of assistance that they receive, perceptions of the quality of their care, feelings about being looked after by a carer and their perceptions of the services which would be useful. A random sample of 531 households were selected as part of a larger study into informal care in the west of Ireland. A total of 98 carers were identified and 55 of the people they looked after were well enough to participate in the study. Over two-thirds of carers assisted with household chores (e.g. cleaning, preparing meals and shopping). Other activities which carers assisted with included keeping the person safe from household accidents (62%), personal care (42%), and dressing and undressing (31%). Whilst most were very satisfied with the quality of care, a minority reported dissatisfaction, and stated that their carer showed signs of anger and frustration. Common concerns related to the health of the carer, their safety when the carer is not available and the cost of being cared for. Financial support for the person receiving care and the carer were the main priorities for these individuals. The present study points to a need for greater involvement of care recipients in planning services relating to informal care, and support and access to health professionals for people receiving care. People receiving care are also concerned about the level of financial support for themselves and their carers. [source] Topical tacrolimus in the treatment of perianal Crohn's disease: Exploratory randomized controlled trialINFLAMMATORY BOWEL DISEASES, Issue 3 2007Ailsa L. Hart PhD Abstract Background The aim of this study is to evaluate the efficacy of topical tacrolimus in treating perianal Crohn's disease. Methods Nineteen patients, stratified into 7 with ulcerating, and 12 with fistulizing, perianal Crohn's disease were randomized to topical tacrolimus 1 mg/g (1 g ointment twice a day [bid]) or placebo for 12 weeks. Sixteen patients had been on, or were currently taking, azathioprine/6-MP, and 6 had received infliximab. The primary outcome in ulcerating disease was global improvement in perianal/anal lesions, as assessed by the attending physician; for fistulas, it was reduction of ,50% of actively draining fistulas on 2 consecutive visits. Blood tacrolimus levels and adverse events were assessed. Results Three of 4 patients treated with topical tacrolimus for ulcerating disease improved compared with none of 3 in the placebo group. Complete healing was not achieved. In fistulizing disease, topical tacrolimus was not beneficial. Two tacrolimus-treated patients developed perianal abscesses, 1 after improvement in fistula drainage. Adverse events were otherwise infrequent and mild. Whole blood tacrolimus levels were detectable in only 2 patients and were low. Conclusions These preliminary data suggest that topical tacrolimus is effective and safe in the treatment of perianal or anal ulcerating Crohn's disease. This therapy is unlikely to be beneficial in fistulizing perianal Crohn's disease, although a larger study is required to confirm this. (Inflamm Bowel Dis 2006) [source] Effects of base excision repair gene polymorphisms on pancreatic cancer survivalINTERNATIONAL JOURNAL OF CANCER, Issue 8 2007Donghui Li Abstract To explore the association between single nucleotide polymorphisms of DNA repair genes and overall survival of patients with pancreatic cancer, we conducted a study in 378 cases of pancreatic adenocarcinoma who were treated at The University of Texas M. D. Anderson Cancer Center between February 1999 and October 2004 and were followed up to April 2006. Genotypes were determined using genomic DNA and the MassCode method. Overall survival was analyzed using the Kaplan,Meier plot, log-rank test and Cox regression. We observed a strong effect of the POLB A165G and T2133C genotypes on overall survival. The median survival time (MST) was 35.7 months for patients carrying at least 1 of the 2 homozygous variant POLB GG or CC genotypes, compared with 14.8 months for those carrying the AA/AG or TT/TC genotypes (p = 0.02, log rank test). The homozygous variants of hOGG1 G2657A, APEX1 D148E and XRCC1 R194W polymorphisms all showed a weak but significant effect on overall survival as demonstrated by either log rank test or multivariate COX regression after adjusting for other potential confounders. In combined genotype analysis, a predominant effect of the POLB homozygous variants on survival was observed. When POLB was not included in the model, a slightly better survival was observed among those carrying none of the adverse genotypes than those carrying at least one of the adverse genotypes. These observations suggest that polymorphisms of base excision repair genes significantly affect the clinical outcome of patients with pancreatic cancer. These observations need to be confirmed in a larger study of homogenous patient population. © 2007 Wiley-Liss, Inc. [source] Cyclin E expression in papillary thyroid carcinoma: Relation to stagingINTERNATIONAL JOURNAL OF CANCER, Issue 1 2004Jan Brzezi Abstract Cyclin E plays a pivotal role in the regulation of G1-S transition and relates to malignant transformation of the cells. However, the clinical significance of cyclin E expression in patients with papillary thyroid carcinoma (PTC) remains unknown. We examined by immunohistochemistry the expression of cyclin E in 41 resected PTCs in pathologic stages from pT1a to pT4 and analyzed its relation to clinicohistopathologic factors. The positive staining was divided into 3 grades: no expression if less than 10%, expression if 11,50% and overexpression if more than 50% of the nuclei of tumor cells were stained positively. Cylin E expressions were observed in 75.6% of analyzed PTCs but only 60% of papillary microcarcinomas (PMCs) were immunopositive for cyclin E expression. However, cyclin E staining was observed in 90.4% of PTCs in a group with TNM higher than pT1a. The staining index was significantly different between the PMCs and the rest of the cancers investigated (14.91% ± 14.4% vs. 34.03% ± 23.44%, respectively; p < 0.005) and we observed positive relation between the staining index and factor T of staging of PTCs. All the lymph node metastases coexisted with cyclin E expression and most, but not all, of them coexisted with cyclin E overexpression. These findings indicate that cyclin E may play a key role for the oncogenesis and biologic behavior of PTC. If our results are confirmed in a larger study, a high level of cyclin E expression may become a new prognostic marker for PTCs. © 2003 Wiley-Liss, Inc. [source] Uncovering the evidence of non-expert nephrology nursing practiceINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 2 2006Ann Bonner BAppSc(Nurs) MA PhD RN MRCNA Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice. [source] Victims of Domestic Violence: A Proposal for a Community Diagnosis Based on One of Two Domains of NANDA Taxonomy IIINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Patricia Serpa de Souza Batista PURPOSE To explore and identify diagnostic components to amplify NANDA nursing diagnoses by modifying the root violence. Whereas violence is nondebatable as a diagnostic concept in nursing, other alternatives have not been identified in the two existing diagnoses. METHODS Using the case study method, this qualitative study sought to identify commonalties in a population of women who were "donnas da casa" (homemakers) in a small rural community of approximately 100 families, typical of the Brazilian northeast. The sample of 7 women was identified through a larger study that had been based on health needs of the community. Data were obtained through observation during a home visit and a semistructured interview based on NANDA Taxonomy II. Observations were focused on hygiene, manner of dress, home environment, and physical and emotional state. Data were analyzed by content and clustered into major categories. From these a profile of the women and another of the partners emerged. FINDINGS Subjects ranged in age from 33 to 43 years, and number of children between 3 and 7. One of the 7 women was literate; 5 were underweight; all were slovenly attired. They appeared sad and older than their age. The majority seemed relieved to unburden themselves to the interviewers as they went through a gamut of emotions such as sadness, anguish, and irritability expressed through crying, restlessness, changes in body language, and tone of voice. The shortage of beds was supplemented by hammocks and mats or cardboard. The women spoke of being confined to their home and of male partners who drank on weekends, thus leaving them with little money for necessities of life. There were accounts of beatings when the partner returned home after drinking, overt nonacceptance of children from previous marriages, and general destruction of the family environment. New children were regarded as just another mouth to feed. DISCUSSION The profiles pointed to the necessity of identifying a new nursing diagnosis that would be linked, only tangentially, by the root violence to the two diagnoses in NANDA Taxonomies I and II. This insight led us to consider that a new method of listing NANDA diagnoses, by root only, is imperative in the evolution of Taxonomy II. Proposed descriptors, Victims of (Axis 3) and Domestic (Axis 6) would be identified by Axes, thereby facilitating the process of classifying in the Domains and Classes. The two existing NANDA diagnoses, risk for other-directed violence and risk for self-directed violence, are proposed for classification in Class 3, Violence, in Domain 11 of Taxonomy II. Safety/Protection could, by virtue of their modification power, find anchor in another domain such as Domain 6, Self-Perception. CONCLUSIONS Although Safety/Protection seems the most logical domain for classification by root, the axes, dimensions of human responses, could pull the diagnosis in another direction, thereby dictating other nursing interventions and nursing outcomes [source] Delirium and older people: what are the constraints to best practice in acute care?INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2008BHSc (Nursing), Jenny Day ADCHN, MEd (Adult Education) An Australian research team conducted a six-month acute care pilot study in a medical ward of a large hospital in New South Wales. Aim., To explore ways health practitioners might redesign their practice to include prevention, early detection and management of delirium in older people based on the best current practice. Method and design., Participatory action research (PAR) was selected as the best approach for involving ward staff to make sustainable clinical practice decisions. The PAR group comprised research academics and eight clinicians from the ward. Thirteen PAR sessions were held over 5 months. Clinicians described care of patients with delirium. Stories were analysed to identify constraints to best practice. Following PAR group debate about concerns and issues, there were actions toward improved practice taken by clinicians. Relevance to clinical practice., The following constraints to best practice were identified: delayed transfer of patients from the Emergency Department; routine ward activities were not conducive to provision of rest and sleep; assisting with the patient's orientation was not possible as relatives were not able to accompany and/or stay with the older patient. Underreporting of delirium and attributing confusion to dementia was viewed as an education deficit across disciplines. A wide range of assessment skills was identified as prerequisites for working in this acute care ward, with older people and delirium. Clinicians perceived that management driven by length of a patient's stay was incongruent with best practice delirium care which required more time for older patients to recover from delirium. Two significant actions towards practice improvement were undertaken by this PAR group: (i) development of a draft delirium alert prevention protocol and (ii) a separate section of the ward became a dedicated space for the care of patients with delirium. A larger study is being planned across a variety of settings. [source] Beliefs about the causes of cervical cancer in Botswana: implications for nursingINTERNATIONAL NURSING REVIEW, Issue 4 2009D. M. McFarland rn Background:, Cervical cancer is the most common cause of cancer mortality and morbidity for women in Botswana. Yet, little is known about what women believe to be the causes of the disease. Aim:, This paper presents data on factors women in Botswana believe are responsible for the high incidence of cervical cancer in their country. Data were part of a larger study that explored knowledge and perceptions about cervical cancer and Pap smear screening from the perspectives of the clients and the healthcare providers. Methods:, The study that generated the data included 30 women of all socio-economic levels, recruited by network sampling. The women's ages ranged from 31 to 54 years. Demographic data were analysed descriptively. Individualized interview data were content-analysed. Findings:, The identified causes of cervical cancer were classified as cervical irritants and non-irritants. The most commonly cited cervical irritants were vaginally inserted chemical agents and traditional medicine. Discussions:, Participants identified vaginally inserted chemical substances and traditional medicines as possible explanations for the high incidence of cervical cancer in Botswana. They reported that women used these substances for sexual and hygienic purposes. Although these factors are believed to be the causes of cervical cancer and have not yet been medically acknowledged, verbal reports suggest that their use is problematic. Conclusion:, There is a need for health education and for further research to affirm women's beliefs about the harmful effects of intravaginal agents. [source] Marginalization of girl mothers during reintegration from armed groups in Sierra LeoneINTERNATIONAL NURSING REVIEW, Issue 4 2007M.E. Burman phd Background:, Although the widespread presence of girls who participate in fighting forces is increasingly recognized, they remain a highly marginalized group globally, receiving little attention either during or after armed conflict. This is especially true for "girl mothers," girls who return to communities with children born while members of fighting forces. Aim:, The concept of marginalization (Hall et al. 1994) is used to examine what happens to girl soldiers, especially girl mothers, in the aftermath of armed conflict when they seek to reintegrate back into their communities. Methods:, This analysis, as part of a larger study of reintegration of girl mothers, is based on field work with girls who were in fighting forces in northwest Sierra Leone, especially those who returned with children. Findings:, The type and level of marginalization these girls experience is consistent with the conceptualization of marginalization; however, they lack voice and experience shame and vulnerability. Moreover, economics were fundamentally related to their marginalization. The girls' access to resources was significantly constrained because the area was heavily impacted by the war and because of widespread poverty throughout Sierra Leone. Discussion:, The findings raise important questions about marginalization of girls affected by war. Girls and girl mothers experience an extremely high level of marginalization; however, some aspects are not consistent with the original conceptualization of marginalization. Theory development in nursing needs to incorporate multiple voices, especially those of the very marginalized and be done in such a manner that benefits and empowers. [source] Professional competence: factors described by nurses as influencing their developmentINTERNATIONAL NURSING REVIEW, Issue 1 2006R. Tabari Khomeiran bs mscn phd Aim:, To discuss the results of a study that explored factors that may influence competence development. Background:, Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence. Methods:, A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis. Findings:, Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge. Conclusions:, The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study. [source] Symptom management for HIV-positive persons in NorwayINTERNATIONAL NURSING REVIEW, Issue 3 2004E. H. Bunch rn Abstract Purpose:, To record symptoms experienced by people with HIV/AIDS, and describe useful self-care strategies and how symptoms impact on daily life. Method:, A questionnaire was used with self-reported answers and descriptions of how symptoms impact on daily activities and suggestions for useful self-care strategies. Four hundred and twenty-two (n = 422) HIV-positive persons from seven sites in the USA and one site in Norway (n = 20) answered the questionnaire. Results:, In this article subjective symptom descriptions from the Norwegian sample are presented along with self-care strategies and their effectiveness. Findings revealed the Norwegian sample to be a little older, maybe less anxious and depressed, than participants in the larger study. This difference might be explained by the structure of the national social and health care system in Norway, where treatments, medications and social services are available to all citizens without cost. Respondents described a number of related symptoms as well as their subjective explanations of what triggered the symptoms. Most of the self-care strategies were learnt by trial and error. Recommendations:, Community health providers, nurses and physicians should become more knowledgeable about the symptoms that infected persons struggle with, as well as the impact these symptoms have on routine daily self-care activities and a person's quality of life. There is need for more research about helpful self-care strategies to assist HIV-positive persons to manage their symptoms and to disseminate these to community health providers and support groups for HIV infected persons. [source] Effects of husbandry parameters on the life-history traits of the apple snail, Marisa cornuarietis: effects of temperature, photoperiod, and population densityINVERTEBRATE BIOLOGY, Issue 1 2006John Aufderheide Abstract. These experiments are part of a larger study designed to investigate the influence of husbandry parameters on the life history of the apple snail, Marisa cornuarietis. The overall objective of the program is to identify suitable husbandry conditions for maintaining multi-generation populations of this species in the laboratory for use in ecotoxicological testing. In this article, we focus on the effects of photoperiod, temperature, and population density on adult fecundity and juvenile growth. Increasing photoperiod from 12 to 16 h of light per day had no effect on adult fecundity or egg hatching and relatively minor effects on juvenile growth and development. Rearing snails at temperatures between 22°C and 28°C did not influence the rates of egg production or egg clutch size. However, the rates of growth and development (of eggs and juveniles) increased with increasing temperature in this range, and when temperatures were reduced to 22°C egg-hatching success was impaired. Juvenile growth and development were more sensitive to rearing density than adult fecundity traits. On the basis of the present results, we conclude that rearing individuals of M. cornuarietis at a temperature of 25°C, a photoperiod of 12L:12D, and a density of <0.8 snails L,1 (with lower densities for juvenile snails) should provide favorable husbandry conditions for maintaining multi-generation populations of this species. [source] Childrens'and Adolescents'Use of Diaries for Sickle Cell PainJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2001Virginia Egbert Maikler ISSUES AND PURPOSE. To evaluate the characteristics of vaso-occlusive episodes, home management of pain and its impact on the daily activities, and a diary as a method of data collection. DESIGN AND METHODS. Forty-six adolescents and 75 children were asked to complete daily diaries during the intervention period of a larger study. RESULTS. Mild pain was recorded 95% of the time; moderate pain, 3%; and severe pain, 1%. The pattern and location of pain varied greatly. Adolescents used more interventions than did children. When pain intensity was mild, 80% of the children/adolescents maintained school, social, and home activities, but decreased play/sport activities. When pain intensity was high, they decreased their participation in all activities. PRACTICE IMPLICATIONS. Sickle cell pain episodes are unpredictable and highly variable. Diaries can enhance children's and adolescents'documentation and communication about their pain experiences. [source] Burnout contagion among intensive care nursesJOURNAL OF ADVANCED NURSING, Issue 3 2005Arnold B. Bakker PhD Aim., This paper reports a study investigating whether burnout is contagious. Background., Burnout has been recognized as a problem in intensive care units for a long time. Previous research has focused primarily on its organizational antecedents, such as excessive workload or high patient care demands, time pressure and intensive use of sophisticated technology. The present study took a totally different perspective by hypothesizing that , in intensive care units , burnout is communicated from one nurse to another. Methods., A questionnaire on work and well-being was completed by 1849 intensive care unit nurses working in one of 80 intensive care units in 12 different European countries in 1994. The results are being reported now because they formed part of a larger study that was only finally analysed recently. The questionnaire was translated from English to the language of each of these countries, and then back-translated to English. Respondents indicated the prevalence of burnout among their colleagues, and completed scales to assess working conditions and job burnout. Results., Analysis of variance indicated that the between-unit variance on a measure of perceived burnout complaints among colleagues was statistically significant and substantially larger than the within-unit variance. This implies that there is considerable agreement (consensus) within intensive care units regarding the prevalence of burnout. In addition, the results of multilevel analyses showed that burnout complaints among colleagues in intensive care units made a statistically significant and unique contribution to explaining variance in individual nurses' and whole units' experiences of burnout, i.e. emotional exhaustion, depersonalization and reduced personal accomplishment. Moreover, for both emotional exhaustion and depersonalization, perceived burnout complaints among colleagues was the most important predictor of burnout at the individual and unit levels, even after controlling for the impact of well-known organizational stressors as conceptualized in the demand-control model. Conclusion., Burnout is contagious: it may cross over from one nurse to another. [source] Models of mental health nurse,general practitioner liaison: promoting continuity of careJOURNAL OF ADVANCED NURSING, Issue 5 2003Terence V. McCann BA MA PhD RMN RGN RNT mccann t.v. & baker h. (2003)Journal of Advanced Nursing 41(5), 471,479 Models of mental health nurse,general practitioner liaison: promoting continuity of care Aim and rationale.,Community mental health nurses and general practitioners share a pivotal role in the provision of mental health care in the community. The focus of this study was to identify models of general practitioner collaboration used by these nurses, and analyse the implications of these models for promoting continuity of care. The study was derived from a larger study of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness. Methods.,This qualitative study used interviews and observation to collect data. The study took place in 1999 in regional and rural New South Wales, Australia and involved community mental health nurses. Findings.,The findings show that two models of nurse and general practitioner (GP) collaboration emerged from the data: Shared Care and Specialist Liaison. In the Shared Care model, nurses maintain close contact with GPs throughout the episode of acute care. In the Specialist Liaison model, the community mental health team assumes overall responsibility for care and treatment throughout the acute episode of illness. Contact with GPs throughout the episode of care by the community mental health team is, at best, intermittent. Conclusion.,The findings suggest that the Shared Care model is more consistent with supporting personal and organizational continuity of care, whereas the Specialist Liaison model is limited to encouraging personal continuity of care but further study is needed. [source] Wound care in the community setting: clinical decision making in contextJOURNAL OF ADVANCED NURSING, Issue 4 2000Christine E. Hallett PhD BNurs BA Hons RGN HVCert DNCert PGDE Wound care in the community setting: clinical decision making in context Sixty-two community nurses in northern England of grades B and D to H were interviewed by a team of four researchers. The interviews were semi-structured, and were tape-recorded, fully transcribed and content analysed. They were conducted as part of a larger study, the aim of which was to examine community nurses' perceptions of quality in nursing care. One of the main themes the work focused on was decision-making as an element of quality. Data relating to wound care were considered from the perspective of the insights they offered into clinical decision-making. Data were interpreted in the light of a literature review in which a distinction had been made between theories which represented clinical decision-making as a linear or staged process and those which represented it as intuitive. Within the former category, three sub-categories were suggested: theorists could be divided into ,pragmatists', ,systematisers' and those who advocated ,diagnostic reasoning'. The interpretation of the data suggested that the clinical decisions made by community nurses in the area of wound care appeared largely intuitive, yet were also closely related to ,diagnostic reasoning'. They were furthermore based on a range of sources of information and justified by a number of different types of rationale. [source] Prediction of Cardiorespiratory Fitness in Older Men Infected with the Human Immunodeficiency Virus: Clinical Factors and Value of the Six-Minute Walk DistanceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Krisann K. Oursler MD OBJECTIVES: To investigate factors related to cardiorespiratory fitness in older human immunodeficiency virus (HIV)-infected patients and to explore the utility of 6-minute walk distance (6-MWD) in measuring fitness. DESIGN: Cross-sectional study in clinic-based cohort. SETTING: Veterans Affairs Medical Center, Baltimore, Maryland. PARTICIPANTS: Forty-three HIV-infected men, median age 57 (range 50,82), without recent acquired immunodeficiency syndrome,related illness and receiving antiretroviral (ARV) therapy. MEASUREMENTS: Peak oxygen utilization (VO2peak) according to treadmill graded exercise testing, 6-MWD, grip strength, quadriceps maximum voluntary isometric contraction, cross-sectional area, muscle quality, and muscle adiposity. RESULTS: There was a moderate correlation between VO2peak (mean ± SD; 18.4 ± 5.6 mL/kg per minute) and 6-MWD (514 ± 91 m) (r=0.60, P<.001). VO2peak was lower in subjects with hypertension (16%, P<.01) and moderate anemia (hemoglobin 10,13 gm/dL; 15%, P=.09) than in subjects without these conditions. CD4 cell count (median 356 cells/mL, range 20,1,401) and HIV-1 viral load (84% nondetectable) were not related to VO2peak. Among muscle parameters, only grip strength was an independent predictor of VO2peak. Estimation of VO2peak using linear regression, including age, 6-MWD, grip strength, and hypertension as independent variables, explained 61% of the variance in VO2peak. CONCLUSION: Non-AIDS-related comorbidity predicts cardiorespiratory fitness in older HIV-infected men receiving ARV therapy. The 6-MWD is a valuable measure of fitness in this patient population, but a larger study with diverse subjects is needed. [source] | |||||||||||||||||||||||||||||||||||||||||||