bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcription factor activation in response to cutaneous injury: Role of AP‐1 in reepithelialization
Authors: YATES SAMANTHA , RAYNER TIMOTHY E.
Published: March 2003

Reepithelialization is the process responsible for restoring an intact epidermis following cutaneous injury. A change in the activity of keratinocytes is required for reepithelialization to occur, and this is likely to be regulated by the altered expression of effector genes, mediated by transcription factors. The injury itself provides a stimulus for transcription factor activation either directly due to mechanical stress, or via paracrine mechanisms such as the release of growth factors from damaged cells. Members of the activator protein‐1 family, in particular c‐fos and c‐jun, have been the most widely studied wound‐induced transcription factors. The signal transduction pathways linking cellular injury to activator protein‐1 stimulation appear to involve an increase in intracellular Ca2+ and activation of mitogen‐activated protein kinases. Given that a number of genes involved in the reepithelialization of wounds are regulated by activator protein‐1, a distinct role for this transcription factor in reepithelialization is beginning to emerge. This article reviews the evidence for activator protein‐1 involvement in reepithelialization, with particular focus on the activation of this transcription factor in response to wounding, the second messenger/kinase pathways involved, and the modulation of downstream genes that have the capacity to regulate keratinocyte function.
Polymetamorphic origin of muscovite+cordierite+staurolite+ biotite assemblages: implications for the metapelitic petrogenetic grid and for P–T paths
Authors: Pattison  , Spear  , Cheney
Published: March 2003

Metapelites containing muscovite, cordierite, staurolite and biotite (Ms+Crd+St+Bt) are relatively rare but have been reported from a number of low‐pressure (andalusite–sillimanite) regional metamorphic terranes. Paradoxically, they do not occur in contact aureoles formed at the same low pressures, raising the question as to whether they represent a stable association. A stable Ms+Crd+St+Bt assemblage implies a stable Ms+Bt+Qtz+Crd+St+Al2SiO5+Chl+H2O invariant point (IP1), the latter which has precluded construction of a petrogenetic grid for metapelites that reconciles natural phase relations at high and low pressure. Petrogenetic grids calculated from internally consistent thermodynamic databases do not provide a reliable means to evaluate the problem because the grid topology is sensitive to small changes in the thermodynamic data. Topological analysis of invariant point IP1 places strict limits on possible phase equilibria and mineral compositions for metamorphic field gradients at higher and lower pressure than the invariant point. These constraints are then compared with natural data from contact aureoles and reported Ms+Crd+St+Bt occurrences. We find that there are numerous topological, textural and compositional incongruities in reported natural assemblages that lead us to argue that Ms+Crd+St+Bt is either not a stable association or is restricted to such low pressures and Fe‐rich compositions that it is rarely if ever developed in natural rocks. Instead, we argue that reported Ms+Crd+St+Bt assemblages are products of polymetamorphism, and, from their textures, are useful indicators of P–T  paths and tectonothermal processes at low pressure. A number of well‐known Ms+Crd+St+Bt occurrences are discussed within this framework, including south‐central Maine, the Pyrenees and especially SW Nova Scotia.
High‐precision relative thermobarometry: theory and a worked example
Authors: Worley  , Powell
Published: March 2003

A number of sources of uncertainty are involved in thermobarometric calculations, the most important of which are associated with analytical precision, activity–composition (a–x) relationships, and thermodynamic data. Statistical treatment of these uncertainties results in relatively large uncertainties on the calculated values of pressure and temperature. Little can be done, at least in the short term, about the magnitude of such uncertainties, and any thermobarometric calculations in which they are not taken into account should be treated with caution. Given that uncertainties associated with a–x models and thermodynamic data are systematic when applied to multiple samples with the same mineral assemblage, a solution to the problem of imprecise absolute thermobarometry can be obtained via a relative thermobarometric technique referred to as the ΔPT  approach. The ΔPT  approach offers a major improvement in the precision of thermobarometry if the calculations can be presented in a ΔPT  context.
Domainal variations of U–Pb monazite ages and Rb–Sr whole‐rock dates in polymetamorphic paragneisses (KTB Drill Core, Germany): influence of strain and deformation mechanisms on isotope systems
Authors: Krohe  , Wawrzenitz
Published: March 2003

Polyphase metamorphic paragneisses from the drill core of the continental deep drilling project (KTB; NW Bohemian Massif) are characterized by peak pressures of about 8 kbar (medium‐P metamorphism) followed by strain accumulation at T >650 °C, initially by dislocation creep and subsequently by diffusion creep. U–Pb monazite ages and Rb–Sr whole‐rock data vary in the dm‐scale, indicating Ordovician and Mid‐Devonian metamorphic events. Such age variations are closely interconnected with dm‐scale domainal variations of microfabrics that indicate different predominant deformation mechanisms. U–Pb monazite age variations dependent on microfabric domains exceed grain‐size‐dependent age variations. In ‘mylonitic domains’ recording high magnitudes of plastic strain, dislocation creep and minor static annealing, monazite yields concordant and near concordant Lower Ordovician U–Pb ages, and the Rb–Sr whole‐rock system shows isotopic disequilibrium at an mm‐scale. In ‘mineral growth/mobilisate domains’, in which diffusive mass transfer was a major strain‐producing mechanism promoting diffusion creep of quartz and feldspar, and in which static recrystallization (annealing) reduced the internal free energy of the strained mineral aggregates, concordant U–Pb ages are Mid‐Devonian. Locally, in such domains, Rb–Sr dates among mm3‐sized whole‐rock slabs reflect post‐Ordovician resetting. In ‘transitional domains’, the U–Pb‐ages are discordant. We conclude that medium‐P metamorphism occurred at 484±2 Ma, and a second metamorphic event at 380–370 Ma (Mid‐Devonian) caused progressive strain in the rocks. Dislocation creep at high rates, even at high temperatures, does not reset the Rb–Sr whole‐rock system, while diffusion creep at low rates and stresses (i.e. low ε/Deff ratios), static annealing and the presence of intergranular fluids locally assist resetting. At temperatures above 650 °C, diffusive Pb loss did not reset Ordovician U–Pb monazite ages, and in domains of overall high imposed strain rates and stresses, resetting was not assisted by dynamic recrystallization/crystal plasticity. However, during diffusion creep at low rates, Pb loss by dissolution and precipitation (‘recrystallization’) of monazite produces discordance and Devonian‐concordant U–Pb monazite ages. Hence, resetting of these isotope systems reflects neither changes of temperature nor, directly, the presence or absence of strain.
Oscillatory zoning in eclogitic garnet and amphibole, Northern Serpentinite Melange, Cuba: a record of tectonic instability during subduction?
Authors: García‐Casco A. , Torres‐Roldán R. L. , Millán G. , Monié P. , Schneider J.
Published: March 2003

Exotic blocks of eclogite from distant localities along the Northern Serpentinite Melange of Cuba have comparable P–T histories that include high‐pressure prograde sections (450–600 °C, >15 kbar) associated with subduction of oceanic lithosphere, and retrograde sections within the albite–epidote amphibolite facies (<500 °C, <10 kbar) related to melange uplift. 40Ar/39Ar and Rb/Sr cooling ages (118–103 Ma) of one of the blocks indicate pre‐Aptian subduction and Aptian–Albian uplift. Detailed X‐ray imaging and profiling further reveals that minerals in these eclogite blocks (notably garnet and amphibole) display subtle but well defined oscillatory zoning that developed along the prograde trajectory of the rocks, previous to attainment of peak eclogitic conditions. The chemistry (e.g. coupled changes of Mg# and Mn in garnet, and of Si, Ti, Al and Na in amphibole) and geometry (euhedral to anhedral shapes) of the oscillations can be interpreted in terms of subtle fluctuations in P–T during the general prograde subduction‐related metamorphic path. A (near‐) equilibrium model is presented for the formation of oscillations at near peak conditions by means of recurrent dissolution‐growth reaction processes. This model for near‐peak conditions, and the chemical signatures of earlier oscillations (notably in amphibole), suggest that episodes of retrogression (upward movement?) affected parts of the subducting slab. It is proposed that these retrograde episodes record the tectonic rupture of the subducting slab and, probably, of the upper plate mantle, either due to the intrinsic dynamic behaviour of subduction systems or to the effects of the plate‐tectonic rearrangement of the Caribbean region during the Early Cretaceous.
Technical Advances in Hemodialysis Therapy
Authors: Parker Tom F.
Published: March 2003

Other than pharmaceutical advancements, the improvements in hemodialysis have largely been due to technical changes. This article summarizes the various technical areas that are noteworthy: hemodialysis membranes; dialysate buffer, electrolyte concentration, and temperature; prescription monitoring; reprocessing; volume‐ultrafiltration control; information system interface; arteriovenous access monitoring; water treatment; and continuous and nocturnal dialysis. Within each category, subjective and objective conclusions are drawn as to whether the technical advancements have translated to improved clinical outcomes. In addition, an hypothesis is proposed that due to a confluence of ownership of research and development, manufacturing of equipment, and dialysis facilities conflicts may arise which could slow future technical developments.
Must We Treat Noncompliant ESRD Patients?
Authors: Friedman Eli A.
Published: March 2003

Coping with the stress induced by ESRD patient noncompliance is a time consuming, nonproductive, demoralizing undertaking that is unavoidable. An orderly, non‐confrontational approach encompassing measures to protect mentally incompetent and unaware patients as well as those too sick to comprehend and consent to therapy (dialysis) is provided. Individual practitioners should utilize all available resources including patient relatives and friends, collaborating psychiatrists, and institutional risk‐management officers to assist in devising the best resolution to what may escalate into an onslaught against the renal care team. No single solution is applicable to the myriad variables that may impinge on a specific patient's seemingly apathetic or hateful behavior underlying noncompliance.
Hormone Replacement Therapy in Postmenopausal Women with End‐Stage Renal Disease: A Review of the Issues
Authors: Holley Jean L. , Schmidt Rebecca J.
Published: March 2003

Hormone replacement is an integral part of therapies to prevent osteoporosis in postmenopausal women and may be considered a component in the treatment of dyslipidemia, cardiovascular disease, and possibly cognitive function. The indications for, and efficacy and prescription of, hormone replacement therapy in postmenopausal women with ESRD have been infrequently studied and less than 10% of postmenopausal women on dialysis are receiving hormone replacement. Small studies suggest that hormone replacement therapy is valuable in treating the dyslipidemia of women on dialysis, but indicate that a reduction in the dosage of hormone replacement may be needed. A potential role for hormone replacement therapy in the treatment and/or prevention of osteoporosis and sexual dysfunction in postmenopausal women on dialysis exists as well.
Access Flow Measurement as a Predictor of Hemodialysis Graft Thrombosis: Making Clinical Decisions
Authors: Krivitski Nikolai M. , Gantela Swaroop
Published: March 2003

Since the introduction of dilution methods for measurement of vascular access blood flow during hemodialysis, more than 170 publications addressing the accuracy, prognostic value, and economic impact of the technology have been presented. Recently researchers (Paulson et al.) have raised concerns about the accuracy of access flow measurements in predicting thrombosis. Our first objective was to address the inadequacies of the analysis by these authors. The second objective was to apply a statistically accepted three‐step approach for clinical decision making to assess the utility of access flow surveillance (similar to the K/DOQI guidelines) in the prediction of thrombosis. These steps included 1) estimation of treatment thresholds based on harm‐benefit analysis of fistulography‐angioplasty versus thrombosis, 2) estimation of prior probability of thrombosis based on patient demographic and clinical characteristics, and 3) application of Bayes' theorem to evaluate whether flow test results provided information that could move patients across the treatment threshold, thus discriminating between patients who should be referred for fistulography‐angioplasty and those who should not. These data and an analysis of recent publications show that the implementation of an access flow surveillance program decreases thrombosis rates in hemodialysis units and can significantly reduce the costs associated with hemodialysis access maintenance. We conclude that access flow monitoring (K/DOQI flow thresholds) is useful in the clinical decision‐making process for thrombosis prediction across a wide range of demographic categories.
Hemodialysis in Acute Renal Failure: Does the Membrane Matter?
Authors: Modi Gopesh K. , Pereira Brian J. G. , Jaber Bertrand L.
Published: March 2003

Patients who develop hospital‐acquired acute renal failure (ARF) that require dialytic support have high mortality rates. The potential impact of dialyzer membrane biocompatibility on clinical outcomes in ARF has been a subject of ongoing controversy. This article summarizes the clinical trials published to date that have examined the effect of dialyzer membrane biocompatibility on clinical outcomes of patients with ARF who require intermittent hemodialysis. A redirection of research endeavors in the field of dialysis in ARF is also argued.
Kinetic Modeling of Continuous Flow Peritoneal Dialysis
Authors: Gotch Frank A.
Published: March 2003

Kinetic models have been derived for analysis of the effects on peritoneal urea clearance (Kp) of continuous single‐pass flow of fresh peritoneal dialysate and continuous flow of peritoneal dialysate recirculating through an external dialyzer. Generalized solution of the models shows that both predict Kp to be a well‐defined function of the peritoneal mass transfer coefficient (MTC) and the dialysance (D) of the external dialyzer, while the MTC is a function of the rate and distribution of dialysate flow. Thus the models should be useful to guide studies to optimize CFPD. Analysis of reported in vivo data indicate that with dialysate flow rate and D both in the range of 200 ml/min, MTC levels of 60–70 ml/min and Kp levels of 50 ml/min can be achieved. If the model predictions are verified in vivo, 8‐hour overnight CFPD 6 nights/week could provide the average‐size anephric patient a weekly stdKt/V of 3.2 which is competitive with daily hemodialysis. Kinetic modeling of ultrafiltration indicated ultrafiltration rates 0.2–0.3 L/hr should be achieved with 1.0–1.25% dextrose dialysate. The model shows average rates of glucose absorption can theoretically be reduced by 33% compared to CAPD with the same amount of fluid removal.
Hemodialysis in the Elderly: Vascular Access and Initiation of Renal Replacement Therapy
Authors: Latos Derrick L.
Published: March 2003

Elderly persons with kidney failure are faced with many important considerations. Factors contributing to the choice of vascular access are often related to issues that also affect the timing of initiation of dialysis. This article provides guidance in determining when elderly patients are likely to develop an increased risk for complications of chronic kidney failure and comorbid conditions, and should therefore assist clinicians in selecting optimal vascular access and in deciding when to advise patients to begin dialysis.
DIALYZING THE ELDERLY: ISSUES AND CONCERNS: Dialysis in Nursing Homes
Authors: Tong Eric M. , Nissenson Allen R.
Published: March 2003

The number of geriatric end‐stage renal disease (ESRD) patients in the United States is increasing disproportionately to other age groups on dialysis. Thus there will be more dialysis patients that will require the assistance of nursing homes or extended care facilities. Nursing homes may be beneficial for the geriatric patient in terms of social and physical rehabilitation. Many of these facilities, however, may not take care of or may not have the capacity to adequately care for dialysis patients. Such patients have a higher rate of peritonitis when on peritoneal dialysis (PD) and have higher mortality rates on hemodialysis (HD) or PD compared to similar dialysis patients in the community. Cooperation and communication between the dialysis center and the nursing home, given the complex management issues involved in the care of these patients, are essential. One promising approach to the care of elderly dialysis patients is an integration of nursing home and dialysis unit. Although another approach could be to more fully utilize the services of adult day care centers, this has proven logistically difficult and has not been reported to be successful since it was first suggested more than a decade ago.
DIALYZING THE ELDERLY: ISSUES AND CONCERNS: Cardiovascular Abnormalities and Hypertension in the Elderly Dialysis Patient
Authors: Dikow Ralf , Zeier Martin , Ritz Eberhard
Published: March 2003

Elderly individuals comprise an ever‐increasing proportion of patients on renal replacement therapy (RRT). As in younger patients, cardiovascular events are the major cause of death in the elderly on RRT, although the relative proportion succumbing to cardiovascular events is similar to that in young patients. An important observation is that the elderly are particularly likely to experience higher mortality if dialysis technique is suboptimal; they also experience particular benefit from successful renal transplantation. The latter observation has led to an “old for old” program in Europe.
Automated Peritoneal Dialysis Symposium: APD in the Elderly
Authors: Kadambi Pradeep , Troidle Laura , Gorban‐Brennan Nancy , Kliger Alan S. , Finkelstein Fredric O.
Published: March 2003

Few elderly patients with end‐stage renal disease (ESRD) are treated with peritoneal dialysis (PD). Among dialysis patients ≥65 years of age reported by the U.S. Renal Data System (USRDS), the percentage treated with chronic peritoneal dialysis (CPD) is lower than in any other age group. To evaluate the effectiveness of automated peritoneal dialysis (APD) in the elderly, we compared several outcome measures in cohorts of different ages maintained on APD. The outcome measures we examined included mortality and technique failure rates, peritonitis rates, outcomes of peritonitis, and quality of life measures. We found that while patients ≥65 years of age have a higher mortality rate than younger patients, technique failure rates, overall peritonitis rates, and most quality of life measures are not different than for younger patients. However, patients ≥65 years of age have higher gram‐negative peritonitis rates and lower scores on the physical component score of the SF‐36 than younger patients. The present study suggests that APD is a reasonable treatment modality for elderly patients with ESRD and that elderly patients with progressive renal failure should be considered as candidates for APD.
Automated Peritoneal Dialysis Symposium: Host Defenses in APD
Authors: Brunkhorst Reinhard R.
Published: March 2003

The incidence of peritonitis in peritoneal dialysis (PD) has further decreased after the introduction of automated peritoneal dialysis (APD) into clinical routine. Technical advances such as a reduction in the number of connections, more motivated patients, and improved host defense mechanisms in APD have been described. We found that the long daytime interval without dialysate exchanges leads to a higher absolute number of peritoneal macrophages which are capable of an improved first‐line host defense. This is demonstrated by a higher release of cytokines of peritoneal macrophages after stimulation with lipopolysaccharides. The dry “day” in nightly intermittent PD seems to have no relevant additional positive effects on peritoneal host defense compared to continuous cyclic peritoneal dialysis. The regeneration of peritoneal cell populations induced by intervals without PD remains relevant even in times when more “biocompatible” PD solutions become available.
Infection with Antimicrobial‐resistant Microorganisms in Dialysis Patients
Authors: Berns Jeffrey S.
Published: March 2003

The prevalence of antimicrobial‐resistant microorganisms in various health care settings, including outpatient dialysis facilities, has increased dramatically in the last decade. Antimicrobial use and patient‐to‐patient transmission of resistant strains are the two main factors that have contributed to this rapid increase. Methicillin‐resistant Staphylococcus aureus (MRSA) and coagulase‐negative staphylococci are commonly isolated as a cause of hemodialysis (HD) catheter‐related bacteremia and peritoneal dialysis (PD)‐related catheter infection and peritonitis. The widespread use of vancomycin in dialysis patients is of concern because of an increase in the prevalence of vancomycin‐resistant enterococci (VRE) in dialysis patients. Staphylococci with reduced sensitivity to vancomycin have also appeared in dialysis patients. A more recent problem is the appearance of S. aureus isolates with a high degree of resistance to the topical antimicrobial agent mupirocin. This has been seen in PD patients who have received prophylactic application of mupirocin at the peritoneal catheter exit site. Appropriate antimicrobial use will help protect the efficacy of currently used antibiotics, such as vancomycin. Published guidelines for use of vancomycin should be followed. New antimicrobials such as linezolid and quinupristin/dalfopristin have activity against VRE and MRSA, but resistance to these agents has already occurred. Preventing transmission of antimicrobial‐resistant microorganisms in health care settings, including outpatient dialysis facilities, is important in limiting the spread of these resistant organisms.
Fellows’ Forum in Dialysis edited by Mark A. Perazella: Does Uremia Protect against the Demyelination Associated with Correction of Hyponatremia during Hemodialysis? A Case Report and Literature Review
Authors: Oo Than Naing , Smith Charles L. , Swan Suzanne K.
Published: March 2003

Rapid correction of chronic hyponatremia is known to cause demyelination syndromes, which are attributed to the rapid shift of water out of the brain. In uremic patients with hyponatremia, depending on the dialysate sodium concentration and delivered Kt/V, serum sodium levels may be rapidly corrected inadvertently during the hemodialysis (HD) session. It is not known whether uremic patients are as susceptible to the development of demyelination as patients with normal renal function. Since urea diffuses slowly across the blood–brain barrier, it can act as an effective osmole between plasma and the brain if levels are changed abruptly. During HD, blood urea levels drop suddenly and significantly and cerebral edema may develop (dialysis disequilibrium syndrome). This effect may counteract the fluid shift out of the brain during correction of hyponatremia. Therefore, theoretically, uremic patients may be less prone to develop demyelination. We present a patient with renal failure whose hyponatremia was corrected rapidly during HD to illustrate the potential problem. The patient tolerated rapid correction of hyponatremia without sustaining any neurologic damage. We performed a literature search looking for similar case reports and reviewed the scientific evidence behind the above hypothesis.
Variations in Urethral Warming Temperatures During Cryosurgery: The Impact On Post‐Treatment PSA Levels
Authors: Gould Robert S.
Published: March 2003

A comparison of prostate specific antigen (PSA) levels at 1 year after cryosurgery is made for three groups of patients: those who underwent standard cryosurgery with the use of a 37°C urethral warmer, those who underwent cryosurgery with the use of a 22°C warmer, and those who underwent cryosurgery with no warmer used. Those patients who underwent standard cryosurgery were further divided into those who had less aggressive disease (by determination of pretreatment PSA level and tumor grade) and those with more aggressive disease. No significant difference was found in the results of treatment by varying the urethral warming temperature. Aggressive tumors did not respond well to standard cryosurgery. Complete ablation of the prostate by freezing without the use of a warming catheter, however, dramatically improved treatment results. Further studies are thereby felt to be warranted.
Acute Complications after Radical Retropubic Prostatectomy
Authors: Ng Christopher S. , Klein Eric A.
Published: March 2003

Objectives: To assess the rate of acute complications after radical retropubic prostatectomy (RRP) using contemporary surgical techniques and perioperative care.

Materials and Methods: We reviewed the records of 306 consecutive patients who underwent RRP with or without bilateral pelvic lymph node dissection under low‐thoracic epidural anesthesia between October 1996 and April 1999. A standardized postoperative regimen was employed including early ambulation, epidural analgesia, and liquid diet the day after surgery.

Results: The median length hospital stay was two nights. Acute complications occurred in 25 (8.2%) of 306 patients and were mostly minor. No thromboembolic or pulmonary events were noted, and there were no deaths. The 30‐day hospital readmission rate was 0.3%.

Conclusion: The contemporary regimen of perioperative management employed in this series of men undergoing RRP results in short hospital stay and a low rate of primarily minor complications.
Reconstructing Organizational Culture: A Process Using Multiple Perspectives
Authors: Cameron Gail , Mah Wren Alice
Published: March 2003

Transformational leadership was an integral part of the process of changing organizational values in a Continuing Care Program. The management team engaged the staff members in a process of reflection‐on‐action where they told stories from practice to define and describe their organizational values. Then the Continuing Care staff solicited feedback from clients and agency personnel about whether or not they experienced the staff “walking their talk.” This was followed by staff participation in problem solving and decision making to find solutions to the issues that arose from the feedback.
Improving Client Outcomes Through Differentiated Practice: A Rural Nursing Center Model
Authors: Anderko Laura , Uscian Mary , Robertson Julie Fisher
Published: March 2003

The TriCounty Community Health Center (the Center) was created in 1994 with federal grant monies to increase access and to provide outreach and primary health care services for rural residents. The Center employs a differentiated practice model of nursing care in which all nurses use the nursing process targeted to client systems that match the nurse's level of educational preparation and competence. The model allows nurses to intervene with various client systems, including the individual, family, aggregate, and community. Program outcomes for the Center suggest that using a differentiated nursing practice model for outreach and primary care services appears to have a positive impact on the health of individuals, families, and aggregates in rural settings, using the Omaha Classification System as a framework for evaluation.
Residential Status and Birth Outcomes: Is the Rural/Urban Distinction Adequate?
Authors: Hulme Polly A , Blegen Mary A
Published: March 2003

In studies comparing the birth outcomes of rural and urban women, residency status is frequently defined dichotomously as either rural or urban. Since residency status appears to be a continuum, however, the usefulness of other categorization systems needs to be explored. The purpose of this study was to compare birth outcomes using a three‐level variable for residency status (rural, rural adjacent to urban, and urban). The study population was comprised of women who delivered by cesarean section over an 18‐month period (N= 263) at a tertiary care hospital. Data were collected from patient charts, interviews, and the hospital information system. Residency status was determined by county of residence. Birth outcomes examined included gestational age, birthweight, Apgar scores, maternal complications, length of hospital stay, and costs of hospital care. Rural women had worse birth outcomes overall and traveled the greatest distance for delivery. Rural‐adjacent women had the best birth outcomes of the three groups, yet were the youngest, least educated, least likely to be married, and the least likely to be privately insured. By using a nondichotomous three‐level variable for residency status, two distinct groups of rural women were identified whose maternal health care needs may differ from each other.
Issues in Balancing Teenage Clients' Confidentiality and Reporting Statutory Rape Among Kansas Title X Clinic Staff
Authors: Miller Corinne , Miller Henry L. , Kenney Linda , Tasheff Jennie
Published: March 2003

Through Federal Welfare Reform, Congress directed states to aggressively enforce statutory rape laws. Family planning professionals deal with many adolescent clients, and their support for such enforcement or willingness to report is unclear. The authors of this study examined current attitudes and practices of family planning program managers (FPPMs) about statutory rape law enforcement, including current reporting practices. In 1997, all 77 local Kansas Title X FPPMs were surveyed. Structured telephone interviews were conducted with 10 FPPMs to add detail to quantitative responses. Sixty‐eight FPPMs responded to the written survey (88%). Of these, 79% supported aggressive enforcement, and 43% thought enforcement would reduce adolescent pregnancy rates. With increased enforcement, 38% believed teenagers would be discouraged from seeking reproductive health care, compared to 41% who believed they would not. Among key informants, all of whom were FPPMs, willingness to report cases was mixed, with those who would report wanting the flexibility to judge on a case‐by‐case basis. For those not reporting cases, confidentiality concerns overrode beliefs in any positive outcome of enforcement. Kansas Title X FPPMs strongly supported aggressive enforcement, but had mixed beliefs about negative consequences. Among those interviewed, there were also mixed beliefs and practices about reporting. Reporting from FPPMs will be sporadic and arbitrary unless protocols are developed and laws are clarified.
Public Health Nursing and Immunization Surveillance
Authors: Zahner Susan J.
Published: March 2003

Public health nurses (PHNs) play critical roles in public health surveillance systems in the United States. Increased understanding of public health surveillance systems can help PHNs appreciate their role in surveillance and improve the quality and usefulness of surveillance data. This paper describes the National Immunization Survey, the public health surveillance system currently in place for tracking immunizations, as well as immunization registries and HEDIS performance indicators, two emerging approaches to immunization surveillance. The contributions of public health nursing to these systems and implications for public health nursing practice are discussed. High quality public health surveillance information is essential for monitoring the progress of disease trends and program effectiveness. PHNs can help assure the quality of surveillance data.
Describing Parish Nurse Practice Using the Nursing Minimum Data Set
Authors: Coenen Amy , Weis Darlene M. , Schank Mary Jane , Matheus Rosemarie
Published: March 2003

The purpose of this study was to describe parish nurses' practice using the framework of the Nursing Minimum Data Set (NMDS). Nineteen parish nurses practicing in 22 faith communities collected data using standardized nursing classification systems (North American Nursing Diagnosis Association [NANDA] Taxonomy and Nursing Intervention Classification [NIC]). A database was developed for quantitative analysis. Nurses recorded 1,557 encounters for services provided to 776 individuals. Over the period studied, the nurses recorded 1,730 nursing diagnoses and 3,451 nursing interventions. The most frequent nursing diagnoses and nursing interventions are reported and emphasized health promotion and illness prevention. The parish nurse roles of educator, counselor, referral agent, and advocate/facilitator, described in the literature, were consistent with the findings of this study. A focus group of the parish nurses provided validation of the results of the database descriptions of practice. The nurses also identified issues related to the use of NANDA and NIC in documenting practice.
Health Protecting and Health Promoting Behaviors of African Americans Living in Appalachia
Authors: Newell‐Withrow Cora
Published: March 2003

The importance of the influence of health protecting and health promoting behaviors on the health of Appalachian African Americans has not been widely published. Review of the literature revealed a paucity of research data describing these behaviors. Therefore, the purpose of this descriptive study was to describe health protecting and health promoting behaviors of Appalachian African Americans. Pender's (1996) health promotion conceptual framework was used as the organizing framework for this study. Data were collected through structured interviews with 204 Appalachian African Americans representing two states and six counties in Appalachia. Quantitative research methodology was used to describe health protecting and health promoting behaviors. Data analysis revealed that these participants actively engaged in health protecting and health promoting behaviors. Morbidity data, mortality data, and family history of diseases were consistent with those reported nationally. Findings from this study support the need for a long‐range research study of Appalachian African Americans.
Therapeutic Use of Parental Stories to Enhance Mexican American Family Socialization: Family Transition to the Community School System
Authors: Niska Kathleen J
Published: March 2003

An ethnographic study was carried out in Hidalgo County, Texas, among 23 Mexican American families to field‐test a methodology of using parental stories to enhance family socialization when a firstborn child enters the community school system. Thirteen of the 23 families shared their parental concerns about the child beginning school in audio‐taped interviews in 1998. In 1999, the investigator assessed the parental concerns of the remaining 10 families who were about to have their children enter the school system. The investigator elicited parental stories of how the 13 experienced families managed their parental concerns during 1998, transcribed 65 parental stories verbatim, and shared the parental stories that addressed the specific concerns of each of the 10 inexperienced families. The assessment showed the stories addressed concerns that were similar, the inexperienced parents acquired new ways of managing their parental concerns, and their overall concern was lessened as a result of listening to the stories.
Learning to Be a Normal Mother: Empowerment and Pedagogy in Postpartum Classes
Authors: Aston Megan L.
Published: March 2003

This qualitative study, which was conducted in the summer of 1992, presents the findings of how six first‐time mothers and two public health nurses experienced pedagogical practices within postpartum classes offered by two public health units in Ontario, Canada. How concerns and aspirations of new mothers were constructed and mediated in the postpartum class are analyzed using concepts from poststructuralist and feminist methodologies. This study goes beyond an analysis of individual teaching and learning styles and discusses how social structures of isolation, investment in a medical discourse, and processes of normalization construct an individual's experiences and practices of mothering, which in turn influence pedagogical practices in postpartum classes. Issues of empowerment, language, support, and knowledge exchange are discussed.
Lymphatic Mapping in the Management of Melanoma in Children
Authors: Brady Mary S. , Weinberg Harvey , Kraus Dennis , Lewis Jonathan J. , Coit Daniel G. , La Quaglia Michael P. , Busam Klaus
Published: March 2003

Abstract: Lymphatic mapping allows the surgeon to identify and remove the first draining (sentinel) lymph node from a primary melanoma with minimal morbidity. The procedure facilitates accurate staging and identification of patients in need of additional therapy. We used lymphatic mapping and sentinel lymph node biopsy in two children with melanoma. Both patients had evidence of metastatic melanoma in their sentinel lymph nodes and underwent regional lymphadenectomy. Malignant melanoma and atypical pigmented lesions in children remain diagnostically challenging for the pathologist and clinician. Misdiagnoses occur, and the correct interpretation of a melanocytic tumor is too often made only after recurrence or metastasis has occurred. The use of lymphatic mapping facilitates accurate staging and identifies children in whom additional therapy may be indicated. In addition, it can assist in the assessment of the biologic potential of a difficult lesion.
Skin Manifestations of Cushing Disease in Children and Adolescents Before and After the Resolution of Hypercortisolemia
Authors: Stratakis Constantine A. , Mastorakos George , Mitsiades Nicholas S. , Mitsiades Constantine S. , Chrousos George P.
Published: March 2003

Abstract: Cushing disease (CD) is a common cause of endogenous hypercortisolism in childhood. Its skin manifestations include striae, facial acne, hirsutism, acanthosis nigricans, fungal infections, hyperpig‐mentation and easy bruisability. We followed 36 children and adolescents with CD (14 boys and 22 girls), to define the natural history of skin disease in endogenous hypercortisolism. Physical examination and 24 hour urinary free Cortisol (UFC) and 17‐hydroxycorticosteroid (17‐OHS) excretion values were obtained preoperatively and quarterly for 18 months. Preoperatively our patients exhibited purple subcutaneous striae (77.7%), steroid‐induced acne (58.3%), hirsutism (63.7% of the 22 girls), acanthosis nigricans (27.7%), ecchymoses (27.7%), hyperpigmentation (16.6%), and fungal infections (11.1%). The levels of UFC and 17‐OHS preoperatively were 351.84 ± 243.85 μg/m2/day (mean ± SD) and 17.92 ± 7.86 mg/g creatinine/day, respectively. No correlation was found between these levels and the severity of the lesions. All patients were cured. Symptoms decreased dramatically within the 3 postoperative months and progressively disappeared within the first year of the follow‐up period with the exception of light‐colored striae; they were present in 5.6% of the patients at 18 months postoperatively. No acanthosis nigricans or hyperpigmentation were observed at 3 months postoperatively. Hirsutism was not present at 9 months postoperatively. We conclude that in children with CD the skin is affected at multiple sites; however, the severity of the manifestations does not correlate with the biochemical indices of the disease. With the exception of striae, cutaneous effects of endogenous hypercortisolism completely heal within the first year after surgical cure of the disease.
Dermatologic Findings in Anorexia and Bulimia Nervosa of Childhood and Adolescence
Authors: Schulze Ulrike M. E. , Pettke‐Rank Claudia V. , Kreienkamp Matthias , Hamm Henning , Bröcker Eva‐B. , Wewetzer Christoph , Trott Götz‐Erik , Warnke Andreas
Published: March 2003

The cutaneous signs of anorexia nervosa (AN) and bulimia nervosa (BN) have been described previously in adult patients. For the first time, we present here dermatologic findings in children and adolescents suffering from eating disorders. Thirty consecutive young anorexic and bulimic inpatients (8 to 17 years of age, mean 15.1 years) underwent a standardized dermatologic examination. Patients were checked for abnormalities of the skin including atopic stigmata, dermographism, hair, nails, and oral cavity. Serum was obtained for hemoglobin, iron, zinc, GPT, thyroid, and sex‐hormone levels. In 13 patients, the total serum IgE was determined, and a prick test was carried out with defined type I allergens. Findings in order of frequency included xerosis of the skin, white dermographism, diffuse hypertrichosis, acrocyanosis, scars, diffuse effluvium, artifacts, brittle nails, and onychophagia. Significant correlations were found between the presence of hypertrichosis and the existence of amenorrhea or a body mass index of less than 16. In 22 patients a low T3 level was found. In summary, children and adolescents suffering from AN or BN show dermatologic features similar to those reported in older patients. Special findings in this age group are extensive lanugo hair and signs of autoaggressive behavior.
Generalized Lupus Panniculitis and Antiphospholipid Syndrome in a Patient Without Complement Deficiency
Authors: Nousari Hossein C. , Kimyai‐Asadi Arash , Santana Helen M. , Diglio Gerardine M. , Tausk Francisco A. , Cohen Bernard A.
Published: March 2003

Abstract: Generalized chronic cutaneous lupus including lupus panniculitis in childhood is rare and usually occurs in the setting of genetic complement deficiencies. The association with antiphospholipid syndrome is even more rare. We report a 13‐year‐old girl with extensive lupus panniculitis since the age of 8 months and no evidence of complement deficiency. She recently developed antiphospholipid syndrome characterized by anticardiolipin antibodies and digital necrosis.
A Pilot Study to Assess the Safety and Efficacy of Topical Calcipotriol Treatment in Childhood Psoriasis
Authors: Park S. B. , Suh D. H. , Youn J. I.
Published: March 2003

Abstract: Childhood psoriasis is more extensive and severe compared with that of adults. Therefore an effective and safe treatment modality is needed. Although a few studies of childhood psoriasis indicate that treatment with calcipotriol is safe and effective, short‐term studies cannot reflect the exact effect of calcipotriol on systemic calcium homeostasis. Our purpose was to study the long‐term efficacy and safety of calcipotriol for childhood psoriasis. An uncontrolled pilot study, with long‐term follow‐up for as long as 106 weeks, using open‐label calcipotriol ointment was conducted in 12 psoriasis patients less than 15 years of age. Response to treatment was assessed by the psoriasis area and severity index (PASI) and serum 25‐hydroxyvitamin D3 and 1,25‐dihydroxyvitamin D3 levels, as well as routine laboratory analyses including serum calcium and phosphate, which were measured before and after the course of treatment. At the end of the study, the patients showed significant improvement in PASI scores compared with the baseline level. No serious side effects, including those related to calcium homeostasis, were detected. The mean values of 1,25‐dihydroxyvitamin D3, however, were decreased and half of the patients had levels below the normal range. In conclusion, it is thought that calcipotriol ointment is an effective treatment modality for long‐term use in childhood psoriasis. However, although not lowering serum calcium and phosphate levels, the long‐term use of calcipotriol in childhood may possibly decrease the serum values of endogenous vitamin D. Therefore monitoring of vitamin D metabolites may be necessary during calcipotriol therapy. More investigative studies are needed to resolve this issue.
Segmental Nevus Depigmentosus: Analysis of 20 Patients
Authors: Di lernia Vito
Published: March 2003

Abstract: Achromic nevus or nevus depigmentosus is a cutaneous abnormality consisting of a hypopigmented macular lesion which can present as circumscribed irregular, oval, or round or as a unilateral band or streak with a blocklike configuration or arranged along one or more Blaschko lines. When it is systematized, it is indistinguishable from hypomelanosis of Ito. Pigmentary anomalies along the lines of Blaschko can be associated with systemic features. For these reasons, 20 children, referred consecutively for evaluation of segmental, linear achromic nevus, were evaluated to define the incidence of associated abnormal systemic features. Extracutaneous abnormalities were present in 2 of 20 children (10%). The anomalies consisted of pes cavus ipsilateral to the hypopigmentation in one child and mental retardation, seizures, and hemihypertrophy in the second. This study confirms that achromic nevus, even when distributed along Blaschko lines, is commonly a benign lesion that is associated with systemic features in a small minority of cases.
Granuloma Annulare of the Eyelid: A Case Report and Review of the Literature
Authors: Sandwich James T. , Davis Loretta S.
Published: March 2003

Abstract: Granuloma annulare is a benign, relatively common dermatosis of childhood. Lesions typically occur on the extremities and resolve spontaneously over a period of several months to years. Localized facial involvement is rare. We report a case of granuloma annulare confined to the left eyelid. The literature on periocular granuloma annulare is reviewed. This diagnosis should be considered for any acquired papules of the periorbital area, especially if there is a history of antecedent trauma. Unnecessary surgical excision can then be avoided.
Deep Dermal Granuloma Annulare Presenting as an Eyelid Tumor in a Child, with Review of Pediatric Eyelid Lesions
Authors: Cronquist Lcdr S. D. , Stashower Lcdr M. E. , Benson Col P. M.
Published: March 2003

Abstract: A case of deep dermal granuloma annulare (GA) involving the eyelid of a child is reported. GA presenting in the periocular region is rare and may mimic other lesions. The differential diagnosis of pediatric eyelid lesions is reviewed.
Subcutaneous Fat Necrosis of the Newborn: A Review of 11 Cases
Authors: Burden A. david , Krafchik Bernice R.
Published: March 2003

Abstract: Subcutaneous fat necrosis (SFN) of the newborn is uncommon and usually occurs in the first weeks of life following a complicated delivery. The frequency with which hypercalcemia develops as a complication is uncertain. We report the clinical features of SFN in 11 patients seen between 1991 and 1998. Ten were born by cesarean section and fetal distress was present in the majority. It was not possible to distinguish SFN from sclerema neonatorum by time of onset or related infant diseases. Hypercalcemia developed in four infants up to 7 weeks after the onset of SFN. Infants with this condition should be carefully monitored for hypercalcemia.