bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of nitric oxide releasing poly(vinyl alcohol) hydrogel dressings on dermal wound healing in diabetic mice
Authors: Masters Kristyn S. Bohl , Leibovich S. Joseph , Belem Paula , West Jennifer L. , Poole‐Warren Laura A.
Published: March 2003

Healing of chronic wounds such as diabetic foot ulcers is a significant clinical problem. Methods of accelerating healing in these difficult lower extremity sites include use of growth factor–loaded gels, hyperbaric oxygen, grafts, and artificial skin replacements. Nitric oxide (NO) has been proposed as a possible active agent for enhancing wound healing. This study examines the in vitro and in vivo responses to a novel hydrogel that produces therapeutic levels of NO. A hydrogel wound dressing was fabricated using ultraviolet light‐initiated polymerization from poly(vinyl alcohol) with a NO donor covalently coupled to the polymer backbone. NO release from the NO‐modified hydrogel was shown to occur over a time period of up to 48 hours, and there was no associated decrease in fibroblast growth or viability in vitro associated with NO hydrogels. Fibroblasts in culture with NO hydrogels had an increased production of extracellular matrix compared with cells cultured without the NO hydrogels. Preliminary animal studies in a diabetic mouse, impaired wound healing model were conducted comparing low (0.5 mM) and high (5 mM) doses of NO. Time to complete closure was similar in control wounds and NO‐treated wounds; however, at 8 days control wounds were significantly smaller than NO‐treated wounds. By days 10 to 13 this delay was no longer apparent. Granulation tissue thickness within the wounds at days 8 and 15 and scar tissue thickness after wound closure were increased in animals exposed to higher dose NO hydrogels. The results of this study suggest that exogenous NO released from a hydrogel wound dressing has potential to modulate wound healing. (WOUND REP REG 2002;10:286–294)
Transient increase in telomerase activity of proliferating fibroblasts and endothelial cells in granulation tissue of the human skin
Authors: OSANAI MAKOTO , TAMAKI TOHRU , YONEKAWA MOTOKI , KAWAMURA AKIO , SAWADA NORIMASA
Published: March 2003

Although granulation tissue formation is an important step for second‐intention wound healing, the molecular events underlying this process are still poorly understood. To investigate the role of telomerase in the formation of granulation tissue, we measured the activity of this enzyme and determined the expression and localization of human telomerase reverse transcriptase mRNA using human skin samples. Telomerase activity in the tip of the granulation tissue where fibroblasts actively proliferate was detected at a level 5.6 ± 1.5 times higher than that at the edge of the tissue when using a polymerase chain reaction‐based telomeric repeat amplification protocol assay coupled with enzyme‐linked immunosorbent assay. This, together with the findings from semiquantitative reverse transcriptase‐polymerase chain reaction and in situ hybridization of human telomerase reverse transcriptase, revealed that proliferating cell nuclear antigen‐positive fibroblasts and endothelial cells in the progressing granulation tissue showed de novo activation of telomerase with high human telomerase reverse transcriptase mRNA expression. This condition may be a prolongation of cellular replicative capacity taking advantage of the positive regulatory dynamics of cell growth. We conclude that the regulation of telomerase activity may play an important role in granulation tissue formation in wound healing.
Chemically modified tetracycline (CMT‐8) and estrogen promote wound healing in ovariectomized rats: Effects on matrix metalloproteinase‐2, membrane type 1 matrix metalloproteinase, and laminin‐5 γ2‐chain
Authors: PIRILÄ EMMA , PARIKKA MATALEENA , RAMAMURTHY NUNGAVARM S. , MAISI PÄIVI , MCCLAIN STEVE , KUCINE ALLAN , TERVAHARTIALA TAINA , PRIKK KAIU , GOLUB LORNE M. , SALO TUULA , SORSA TIMO
Published: March 2003

Estrogen deficiency is associated with impaired cutaneous wound healing. Remodeling of the extracellular matrix in wound healing involves the action of matrix metalloproteinases on basement membrane zone components, especially laminin‐5. We studied the effects of estrogen and a potent matrix metalloproteinase inhibitor, chemically modified non‐antimicrobial tetracycline, CMT‐8, on wound healing in ovariectomized rats. At the tissue level, laminin‐5 γ2‐chain expression was decreased and the migration‐inductive 80 kDa form of laminin‐5 γ2‐chain was absent in ovariectomized rats when compared with sham and CMT‐8‐ or estrogen‐treated ovariectomized animals as detected by Western blotting. The highest levels of gelatinolytic activity (matrix metalloproteinase‐2 and ‐9) were found in sham animals. Levels were reduced in ovariectomized rats and were lowest after treating ovariectomized rats with CMT‐8 or estrogen as analyzed by functional activity assay and zymography. The total amount of membrane type 1‐matrix metalloproteinase was unchanged in all groups. We conclude that CMT‐8 and estrogen can promote wound healing in ovariectomized rats, not only by normalizing wound bed total collagen content and structure, but also by recovering the expression and processing of key molecules in wound healing, i.e., laminin‐5 γ2‐chain. This study shows, for the first time, the role of estrogen and CMT‐8 in laminin‐5 γ2‐chain modulation in vivo.
Syn‐tectonic pluton intrusion during contractional deformation: microstructural and metamorphic evidence from the aureole of the Acadian Victory Pluton, north‐eastern Vermont, USA
Authors: HANNULA  , LACKEY  , MATTOX  , MCGRATH  , ONASCH  , WERTHEIM
Published: March 2003

Structures within the aureole of the Acadian (Devonian) Victory Pluton suggest that movement along the Monroe Fault occurred during pluton intrusion. Pre‐ or syn‐tectonic garnet textures, including discordant internal and external foliations, sigmoidal inclusion trails and deflection of the matrix foliation around garnet, are found along the Monroe Fault. In sillimanite+K‐feldspar grade rocks, the matrix foliation, defined by biotite and fibrolitic sillimanite, wraps around garnet and sillimanite porphyroblasts. Granite dykes and sills near the pluton contact are folded and boundinaged, and leucosome fills garnet pressure shadows and shear bands. Away from the fault and pluton contact, microstructures indicate much less deformation during metamorphism, suggesting that deformation was partitioned into the fault or the pluton. Deformation ceased before crystallization of the main body of the Victory Pluton was complete. It is possible that magmatism facilitated deformation along the Monroe Fault, and/or that the magma was transported to the mid‐ to upper crust along the Monroe Fault. This study suggests that Acadian deformation in north‐eastern Vermont occurred as late as 390–370 Ma.
Amphibolites with staurolite and other aluminous minerals: calculated mineral equilibria in NCFMASH
Authors: Arnold  , Powell  , Sandiford
Published: March 2003

Amphibolite facies mafic rocks that consist mainly of hornblende, plagioclase and quartz may also contain combinations of chlorite, garnet, epidote, and, more unusually, staurolite, kyanite, sillimanite, cordierite and orthoamphiboles. Such assemblages can provide tighter constraints on the pressure and temperature evolution of metamorphic terranes than is usually possible from metabasites. Because of the high variance of most of the assemblages, the phase relationships in amphibolites depend on rock composition, in addition to pressure, temperature and fluid composition. The mineral equilibria in the Na2O–CaO–FeO–MgO–Al2O3–SiO2–H2O (NCFMASH) model system demonstrate that aluminium content is critical in controlling the occurrence of assemblages involving hornblende with aluminous minerals such as sillimanite, kyanite, staurolite and cordierite. Except in aluminous compositions, these assemblages are restricted to higher pressures. The iron to magnesium ratio (XFe), and to a lesser extent, sodium to calcium ratio, have important roles in determining which (if any) of the aluminous minerals occur under particular pressure–temperature conditions. Where aluminous minerals occur in amphibolites, the P–T–X dependence of their phase relationships is remarkably similar to that in metapelitic rocks. The mineral assemblages of Fe‐rich amphibolites are typically dominated by garnet‐ and staurolite‐bearing assemblages, whereas their more Mg‐rich counterparts contain chlorite and cordierite. Assemblages involving staurolite–hornblende can occur over a wide range of pressures (4–10 kbar) at temperatures of 560–650 °C; however, except in the more aluminous, iron‐rich compositions, they occupy a narrow pressure–temperature window. Thus, although their occurrence in ‘typical’ amphibolites may be indicative of relatively high pressure metamorphism, in more aluminous compositions their interpretation is less straightforward.
Prograde pressure–temperature paths in the pelitic schists of the Sambagawa metamorphic belt, SW Japan
Authors: Inui M. , Toriumi M.
Published: March 2003

Prograde P–T paths recorded by the chemistry of minerals of subduction‐related metamorphic rocks allow inference of tectonic processes at convergent margins. This paper elucidates the changing P–T conditions during garnet growth in pelitic schists of the Sambagawa metamorphic belt, which is a subduction related metamorphic belt in the south‐western part of Japan. Three types of chemical zoning patterns were observed in garnet: Ca‐rich normal zoning, Ca‐poor normal zoning and intrasectoral zoning. Petrological studies indicate that normally‐zoned garnet grains grew keeping surface chemical equilibrium with the matrix, in the stable mineral assemblage of garnet + muscovite + chlorite + plagioclase + paragonite + epidote + quartz ± biotite. Pressure and temperature histories were inversely calculated from the normally‐zoned garnet in this assemblage, applying the differential thermodynamic method (Gibbs' method) with the latest available thermodynamic data set for minerals. The deduced P–T paths indicate slight increase of temperature with increasing pressure throughout garnet growth, having an average dP/dT of 0.4–0.5 GPa/100 °C. Garnet started growing at around 470 °C and 0.6 GPa to achieve the thermal and baric peak condition near the rim (520 °C, 0.9 GPa). The high‐temperature condition at relatively low pressure (for subduction related metamorphism) suggests that heating occurred before or simultaneously with subduction.
An automated strategy for calculation of phase diagram sections and retrieval of rock properties as a function of physical conditions
Authors: Connolly J. A. D. , Petrini K.
Published: March 2003

We formulate an algorithm for the calculation of stable phase relations of a system with constrained bulk composition as a function of its environmental variables. The basis of this algorithm is the approximate representation of the free energy composition surfaces of solution phases by inscribed polyhedra. This representation leads to discretization of high variance phase fields into a continuous mesh of smaller polygonal fields within which the composition and physical properties of the phases are uniquely determined. The resulting phase diagram sections are useful for understanding the phase relations of complex metamorphic systems and for applications in which it is necessary to establish the variations in rock properties such as density, seismic velocities and volatile‐content through a metamorphic cycle. The algorithm has been implemented within a computer program that is general with respect to both the choice of variables and the number of components and phases possible in a system, and is independent of the structure of the equations of state used to describe the phases of the system.
Constraints on the duration of high‐pressure metamorphism in the Tauern Window from diffusion modelling of discontinuous growth zones in eclogite garnet
Authors: Dachs E. , Proyer A.
Published: March 2003

An eclogite sample from the Grossgockner region of the Hohe Tauern, Austria contains garnet with a pronounced compositional discontinuity between a Mn‐rich core and an Fe‐rich rim. This jump in composition was caused by a garnet‐consuming reaction followed by growth of the garnet rim + omphacite and marks the prograde transition from epidote–amphibolite to eclogite facies metamorphism. Garnet growth ended at peak metamorphic conditions of 570 °C, 17 kbar, but intracrystalline diffusion continued until about 450 °C, 4 kbar on the retrograde path. This garnet overgrowth texture represents a natural diffusion couple and a time span of 1 Myr was calculated from the diffusion profile developing out of the original sharp compositional step. For typical crustal densities, this time corresponds to a minimum average velocity in the range 4.6–7.4 cm yr−1 (for vertical movement), which is one of the fastest exhumation rates reported. The diffusion of all divalent cations of four profiles was modelled, both analytically and numerically. Both approaches gave comparable results, but the times computed for each element were always discrepant up to a factor of 2. Variations of diffusion coefficients within 2 in analytical calculations remedied this and gave consistent upper time limits. Numerical modelling does not require the simplifications introduced in the analytical approach. On the other hand, error propagation was computationally unfeasible with this method.
Dialyzer Reuse: What We Know and What We Don't Know
Authors: Kaplan Andre A.
Published: March 2003

Despite extensive clinical experience, the effects of different reuse procedures have not been fully evaluated. The available data suggest that the effect of reuse on dialyzer performance depends upon the type of chemicals employed, the membrane type, and the size of the solute whose removal is being assessed. The effect of reuse on urea clearance is essentially defined by the residual cell volume with a total cell volume of > 80% associated with a dialyzer clearance that is within 10% of its original value. The effect of reuse on large solute clearance can be dramatic, with the procedure resulting in substantial changes in the β2‐microglobulin clearance of different dialyzers. Of note is the limited data available regarding the effect of reuse procedures on dialyzers processed more than 20 times.
Local Implementation of Clinical Practice Guidelines and Continuous Quality Improvement: Challenges and Opportunities
Authors: Diamond Louis H.
Published: March 2003

Implementing clinical practice guidelines (CPGs), disease management programs, and quality improvement projects requires an understanding of the trends that will facilitate adoption at the local level. These trends include consumerism and the building of a national information technology infrastructure. The recommendations of the Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry and the Institute of Medicine (IOM) report entitled “To Err Is Human: Building a Safer Health System” will frame developments and implementation. The relative roles and responsibilities of national entities, with coordination and integration of these activities with local efforts will need to be carefully orchestrated. Utilizing the Web to connect dialysis facilities, patients, and members of the health care delivery team has the potential to reap large benefits. Utilizing information technology at the point of care and retrospectively to improve decision making by all parties has the real potential to improve patient outcomes.

Implementation of what at a local level? And what do we mean when local level is referred to? This article addresses these two questions and provides a framework for the engagement of patients, physicians, and members of the health care delivery team and organizations, at both the local and national levels, in improving patient outcomes. All have their roles, rights, and responsibilities. We are challenged to provide the right treatment, to the right patient, at the right time. And importantly, to provide the right information, to the right person, at the right time.
Noninfectious Causes of Cloudy Peritoneal Dialysate
Authors: Rocklin Michael A. , Teitelbaum Isaac
Published: March 2003

The appearance of cloudy dialysate fluid in combination with the clinical manifestations of peritonitis usually heralds infectious peritonitis. Diagnosis is readily established in most cases by routine culture of the turbid dialysate. However, an occasional patient presents with culture‐negative, cloudy dialysate. After ruling out atypical infectious etiologies, a diverse set of aseptic causes remains in the differential diagnosis. Herein we review these causes and suggest an organizational scheme, based on identifying the cellular or noncellular constituent producing the dialysate turbidity, to facilitate appropriate diagnostic and therapeutic interventions.
Imaging Techniques in the Diagnosis of Dialysis‐Related Amyloidosis
Authors: Ketteler Markus , Koch Karl Martin , Floege Jürgen
Published: March 2003

β2‐microglobulin amyloidosis (Aβ2M) is a major determinant of morbidity in patients on dialysis treatment. Symptoms of Aβ2M amyloid are mainly related to (peri‐)articular amyloid deposition. Imaging techniques [i.e., joint ultrasonography, X‐ray, computed tomography (CT), or magnetic resonance imaging (MRI) findings], as well as conventional bone scans, are helpful in the screening of local lesions but are relatively nonspecific and/or not sensitive enough. Scintigraphic techniques using radiolabeled serum amyloid P component (SAP) or the radiolabeled Aβ2M precursor protein, β2M, generate more specific results. Aβ2M deposits have been visualized in several long‐term hemodialysis patients by using 123I‐labeled SAP. However, this scan did not show tracer accumulation in some frequently involved sites such as hips or shoulders, and frequently labeled the spleen, which is usually spared from Aβ2M deposits. Improvements in technical sensitivity and specificity could be achieved by scanning with 131I‐labeled β2M: this technique detected tracer accumulations corresponding to the typical distribution pattern of Aβ2M. Further, both the radiation exposure and the optical resolution of this latter scan have been refined by substituting 111In for 131I. In a final step we generated recombinant human β2M (rhβ2M). While 111In rhβ2M again failed to show significant tracer accumulation over joint regions in patients on short‐term hemodialysis without evidence of Aβ2M, local tracer accumulations similar to those observed with natural, 111In‐labeled β2M could be demonstrated in long‐term hemodialysis patients with evidence of Aβ2M. In conclusion, scintigraphy for Aβ2M with 111In‐labeled rhβ2M provides a homogeneous and safe recombinant protein source and represents a suitable detection method of β2M amyloid deposits in dialysis patients.
Laparoscopic Live Donor Nephrectomy: Rationale, Techniques, and Implications
Authors: Potter Steven R. , Buell Joseph F. , Hanaway Michael , Woodle E. Steve
Published: March 2003

Laparoscopic live donor nephrectomy (LDN) was conceived as a means for decreasing donor nephrectomy morbidity and reducing disincentives for kidney donation. Since LDN was first reported in 1995, explosive growth has led to its performance at more than 100 centers worldwide. Despite initial skepticism in some segments of the transplant community, the results of LDN have improved progressively so that it is emerging as a new standard of care for live kidney donation. We review the development and refinement of LDN and its current rationale and applications.
Postprostatectomy External Beam Irradiation
Authors: Kaplan Irving , Jiroutek Michael , Henry D. Laury , Beard Clair J. , D'Amico Anthony V.
Published: March 2003

Background: A significant proportion of patients will be found to have extracapsular disease and/or detectable prostate specific antigen (PSA) values after radical prostatectomy. The role of postoperative radiotherapy to the prostatic tumor bed remains controversial.

Methods: Ninety patients were treated at the Joint Center for Radiation Therapy after radical prostatectomy. The medium dose to prostatic fossa was 64.0 Gy. Medium follow‐up was 28.9 months (from time of prostatectomy). Failure after radiotherapy is defined as a persistently detectable PSA level or the development of a detectable PSA level after radiotherapy. None of the patients received androgen ablative therapy until documented postradiotherapy failure. Presurgical PSA levels, Gleason score, pathological findings at surgery, and preradiotherapy PSA levels were analyzed as predictors of PSA failure.

Results: A presurgical PSA of >20.0 ng/ml is associated with PSA failure after radiotherapy (p = 0.0239). Preoperative Gleason score, PSA at time of radiotherapy or pathological findings at surgery do not predict for subsequent PSA failure.

Conclusion: Postprostatectomy radiotherapy to the prostatic fossa is unlikely to provide long‐term PSA‐defined, disease‐free survival for patients who undergo prostatectomy with a presurgical PSA of >20 ng/ml. Regardless of findings at surgery, these patients have a high rate of developing PSA failure.
Understanding Barriers to the Early Detection of Prostate Cancer Among Men of Lower Socioeconomic Status
Authors: Dale William , Sartor Oliver , Davis Terry , Bennett Charles L.
Published: March 2003

Objectives: Prostate cancer accounted for more than 180,000 new cases and almost 40,000 deaths in the United States in 1998. Higher rates of mortality have been noted among racial minorities and lower socioeconomic status groups, primarily because of advanced stage of cancer at presentation. Understanding barriers toward early detection of prostate cancer may help diminish these variations.

Materials and Methods: Thirty‐two focus group sessions with individuals of lower socioeconomic status addressed attitudes toward physical examinations, prostate cancer, and sources of health‐care information. Barriers to early detection were identified, based on transcripts that were analyzed using the Health Belief Model.

Results: Most men of lower socioeconomic status viewed physical examinations negatively, with barriers including time, monetary costs, negative impressions of the prostate examination, and lack of belief in early detection. Among the minority of men who had had prostate examinations, they typically did so as part of examinations for chronic medical conditions or because of employer requirements for routine check‐ups. The rectal examination was viewed very negatively because of concerns of physical pain, social embarrassment, and uncertain value. Fear and fatalism regarding prostate cancer were expressed by the majority of attendees. With respect to sources of health information, men typically received health‐care information from the media, with television being the most common source. No significant differences in barriers to early detection efforts were observed between focus groups composed of white versus African American poor men.

Conclusions: The Health Belief Model provides a framework for evaluating the perceptions of men of lower socioeconomic status toward the early detection of prostate cancer. Negative perceptions regarding physical examinations and skepticism about the value of early detection were major barriers to the early detection of prostate cancer. Targeted strategies directed at each of these barriers are needed to improve the rates of early detection in men of lower socioeconomic status.
Bacillus Calmette‐Guerin Immunotherapy Significantly Prolongs Survival of Animals with Prostate Cancer
Authors: Lamm Donald L. , Riggs Dale R. , Donley David , White Justin , Yeater Rachel , Bryner Randy W.
Published: March 2003

Objectives: Bacillus Calmette‐Guerin (BCG) is the treatment of choice for carcinoma in situ of the bladder, but its application to other cancers is very limited. The current study evaluates the effect of intralesional BCG in the PA3 rat prostate cancer model.

Materials and Methods: One hundred five rats were randomized to four groups. Each group received 1 × 106 PA3 cells subcutaneously on experiment Day 0. On experimental Day 7, the groups received the first of six weekly treatments. Treatments consisted of saline solution, BCG 1 × 104 colony‐forming units (cfu), BCG 1 × 105 cfu, and BCG 1 × 106 cfu. All animals were monitored for tumor growth throughout the duration of the experiment.

Results: Animals receiving treatments with BCG 1 × 106 cfu exhibited the greatest reduction in tumor volume ([mean ± SD] 4130.0 ± 1738.3 mm3; p = 0.0738), followed by those receiving BCG 1 × 104 cfu (4527.6 ± 1932.7 mm3; p = 0.1093) and BCG 1 × 105 cfu (4838.2 ± 1889.9 mm3; p = 0.5218), compared to those receiving the saline solution control (5445.0 ± 3119.5 mm3). Animal survival on Day 60 after transplantation was significantly increased in the group receiving BCG 1 × 106 cfu (19 [73.1%] of 26 animals; p = 0.0326) when compared to those receiving the saline solution control (12 [44%] of 27 animals). Treatment with BCG 1 × 105 cfu (11 [42.3%] of 26 animals survived; p = 0.5479) and BCG 1 × 104 cfu (13 [50%] of 26 animals survived; p = 0.4484) also reduced survival compared to the saline solution control, but not to the level of significance.

Conclusions: The consistent reduction in tumor growth and animal mortality in animals receiving intralesional BCG demonstrates antitumor activity in this aggressive model of prostate cancer. The greatest efficacy was seen with the highest dose of BCG, suggesting that higher doses may be optimal in this model. BCG immunotherapy of prostate cancer warrants clinical evaluation.
Expanding Urban Learning Experiences For Non‐Traditional Students
Authors: Shiber Stella
Published: March 2003

Educating nurses in the motivation and ability to provide appropriate and quality health care to urban inner‐city residents with complex and multiple health problems has been a continuing challenge to academic institutions. Recruiting appropriate students and providing meaningful learning experiences is the first of many challenges. Understanding and addressing the many barriers to accessing health services is an important learning outcome. Successful providers with underserved populations have been found to have a strong sense of service to humanity and pride in making a difference and have thrived on the challenges of creatively using limited resources to deal with their patients' complex needs. Establishing a Returned Peace Corps Fellows program and a community health nursing track within the undergraduate program in nursing has provided some successes and additional answers. While studying for a professional degree, the Fellows are placed in a service position to integrate their Peace Corps experiences into new professional learning as it is taking place and to earn a stipend to assist with the cost of their education. This has led to the development of a community health nursing track in the undergraduate program, a combination of required‐for credit courses, credit‐earning enrichment and independent study experiences, and stipend‐earning clinical experiences outside the curriculum.
Quantifying Client Need for Care in the Community: A Strategy for Managed Care
Authors: Hays Bevely J , Sather Linda , Peters Donna Ambler
Published: March 2003

The Community Health Intensity Rate Scale (CHIRS) is a tool that provides an index of a client's need for care. Emphasis in healthcare has shifted from episodes of illness to covered lives and managed care. CHIRS contains all the elements for holistically determining the intensity of a client's need for care and the environmental, psychosocial, and health behaviors of the client. The CHIRS has been utilized with a variety of community health populations. Each application of CHIRS provided feedback to the researchers for use in revising CHIRS. This article reports the findings of a study which tested the validity and reliability of the refined version of CHIRS. The validity and reliability needed further refinement at the indicator level. The study produced a more practical tool for determining intensity of need for clients in the community.
Surveillance of Suicidal Behavior in Kitsap County, Washington: A Retrospective Study
Authors: Simmons Nancy A. , Peterson Jane W. , Hale Christiane
Published: March 2003

Suicide is a major source of preventable morbidity and mortality in Kitsap County, Washington State. This article describes a study of suicidal behavior to identify risk groups in order to design intervention strategies. A retrospective study was conducted by reviewing the charts of individuals exhibiting suicidal behavior who had presented to the county's only civilian hospital emergency department over a 7 month period. Frequencies were calculated to identify at‐risk populations and determine risk factors. One hundred forty‐five charts were reviewed. Subjects were mostly female (69%), and ages ranged from 10 to 80 years with 73% between 15 and 44 years. Two‐thirds of the subjects were not working. More than half had previously exhibited suicidal behavior and more than 75% had previous mental health encounter(s). Most admissions (67.6%) occurred between 4:00 p.m. and 4:00 a.m. The core public health functions of assessment, policy development, and assurance provided the framework for this community to explore the finding that suicide was a major source of preventable morbidity and mortality. Community‐based intervention strategies have been developed in an effort to reach the Healthy People 2000 objective of reducing suicide deaths to no more than 10.5 per 100,000 residents.
Mom Empowerment, Too! (ME2): A Program for Young Mothers Involved in Substance Abuse
Authors: Baldwin Joan H. , Rawlings Ann , Marshall Elaine S. , Conger Cynthia O'neill , Abbott Kimberly A.
Published: March 2003

Substance abuse among young people is of critical concern to public health nurses. When substance abusers are young mothers without the skills, experience, guidance, or resources to become adequate parents, this problem is compounded. This study examined a community‐based intervention program for young mothers from the perspective of 42 participants. A qualitative, descriptive design was used within a process of participatory action research. Two major domains emerged from the data: risk perceptions and behaviors, and health promoting perceptions and behaviors. The study demonstrated the value of obtaining data from the participants and offers implications for practice and research.
Finding Ways to Create Connections Among Communities: Partial Results of an Ethnography of Urban Public Health Nurses
Authors: Schulte Judeen
Published: March 2003

The purpose of this ethnographic study was to describe the culture of public health nurses (PHNs) in a large, Midwestern urban health department. Data collection methods, data management, and analyses followed ethnographic procedures and resulted in the development of categories, domains, and cultural themes. The general study participants were PHNs, clients, supervisors, and administrators. The primary cultural theme that emerged was that public health nursing is finding ways to create connections among communities. Three interacting communities were identified: the local communities, communities created by individuals and families, and communities of resources. This article describes one of the three subthemes that emerged, processes used to help clients create connections, and describes how caring is shown uniquely in public health nursing. As a result of the study, implications for nursing practice, education, and research were developed. The results of the study supported a position that public health nursing is a unique nursing specialty. It reinforced also the applicability of an ethnographic design and methodology to nursing research.
Personal Safety, Violence, and Home Health
Authors: Fazzone Patricia A. , Barloon Linda Funk , McConnell Susan J. , Chitty Julie A.
Published: March 2003

A critical issue facing the health care industry today is the potential impact of community and interpersonal violence on home health care. The purposes of this study were to (1) serve as a source for understanding the personal safety risk issues facing home care staff in a large Midwest region and its surrounding rural areas; (2) provide an understanding of how perceived threats to personal safety may impact patient care and patient outcomes; (3) identify strategies for increasing the personal safety of direct care staff; and (4) identify organizational, educational, and procedural issues that impede or enhance staff safety. A triangulated qualitative design was used including focus groups, in‐depth individual interviews, critical event narratives, and a participant self‐report form. The study used a purposive sample consisting of 5 men and 56 women who were either administrators or direct care staff from 13 home health agencies. Seven major themes emerged: (1) unsafe conditions that direct care staff must face; (2) organizational and administrative issues that impede or promote the personal safety of staff; (3) ethical issues staff face daily; (4) protective factors associated with maintaining safety; (5) issues of gender, race, age, and experience; (6) education and training; and (7) the potential impact that staff's fear of interpersonal and community violence can have on patient care and patient outcomes.
Impact of the Caring for Aging Relatives Group Program: An Evaluation
Authors: Kaasalainen Sharon , Craig Dorothy , Wells Donna
Published: March 2003

Caregiver support programs have been developed with the goal of alleviating the stress associated with the demanding role of caring for an older person. The majority of these programs, however, have not been formally evaluated. This study is a formal program evaluation which assessed the impact of a caregiver support program on its participants. Both the intervention and matched comparison groups included a convenience sample of 23 female caregivers. A quasi‐experimental pretest–posttest design was used to measure morale, social support, and information. Findings showed there was a positive relationship between morale and social support. In the comparison group only, there was a positive relationship between morale and information in both the pretest and posttest. Within the intervention group, there was a significant increase (t= 2.79, p= 0.01) in the information scores between the pretest and posttest. Caregivers in the intervention group reported that the Caring for Aging Relatives Group (CARG) provided them with social support. The results of this study partially supported the usefulness of a caregiver support program; that is, information was gained, morale was maintained, and caregivers perceived the support program as helpful. Future research is needed to address what factors lead caregivers to attend a support program and what type of social support they receive from attending such a program.
Extending the Extended Family for Homeless and Marginally Housed African American Women
Authors: Killion Cheryl M
Published: March 2003

Young homeless African American women and elderly marginally housed African American women have health, housing, and personal concerns specific to their age cohort, yet they also have parallel and complementary needs. The young struggle to find affordable housing, while the old may have difficulty in maintaining their homes. This article reports select findings from a pilot study designed to describe these two groups of women. The preliminary study was conducted preparatory to the development of a larger study to explore factors that would facilitate or hinder linking the two groups of women for mutual assistance in housesharing arrangements. Interviews and housing history findings revealed contrasts and similarities among the women and between both cohorts that reflected individual differences, common yet divergent life courses, and collective responses to family life situations, societal trends, and policies. Advantages and disadvantages of housesharing were delineated with 56.3% of the homeless women and 81.3% of the elderly women viewing coresidential living as an option worth considering. Housesharing arrangements should be further investigated by nurses and colleagues. Findings from this study are foundational for establishing alliances that may be a means to promote health and strengthen “family” in both populations.
Home Visitation Practice: Models, Documentation, and Evaluation
Authors: Drummond Jane E. , Weir Angela E. , Kysela Gerard M.
Published: March 2003

This article presents an evaluation of an in‐home support program for at‐risk mothers and their children. The program was multidisciplinary and was focused on development of parenting capacity and child‐development competencies. The authors examine issues and problems that resulted from the blending of two models of practice—stabilization/crisis intervention and early intervention/health promotion—and describe the outcome‐based evaluation that was used to assess initial and ongoing child development, parent–child interaction, family environment, and social support. When documentation and evaluation of practice and its effect on outcomes proved a considerable challenge, the authors developed a classification system to describe practice in three areas: situations addressed, interventions used, and referrals made. The article describes challenges surrounding program development, implementation, and evaluation.
Maternal Resources, Parenting, and Dietary Patterns Among Rural African American Children in Single‐Parent Families
Authors: Lee E. Juanita , Murry Velma McBride , Brody Gene , Parker Veronica
Published: March 2003

A correlation study was designed to test the hypothesis that maternal education, perceived family resources, and the importance of family routines would be related to children's dietary patterns. Additionally, the study examined the hypothesis that dietary patterns would be associated with children's cognitive and physical abilities. The sample for this study included 159 African American single‐mother families with a 6‐ to 9‐year‐old child living in rural areas, most of whom lived in poverty. Children's eating patterns were assessed using a self‐report questionnaire administered to the mother in an interview format. Children's cognitive ability was measured by several subscales from the Woodcock Johnson Psycho‐Educational Instrument and the Harter Perceived Competence Scale for children. For male children, the mother's higher education was related to more adequate eating patterns at home, and more perceived family resources were related to the likelihood of taking vitamin supplements. For female children, greater milk intake was positively related to cognitive outcomes, including applied problem, passage comprehension, calculation, synonym identification, antonym identification, and quantitative concept scores. Milk intake was clearly related to more optimal cognitive development. The results of this study support the literature related to the importance of nutrition for cognitive and physical abilities in children.
A Community‐Based Approach to Sexual Assault
Authors: Hatmaker Debra D. , Pinholster Linda , Saye Jennifer J.
Published: March 2003

The community‐based Athens‐Clarke County Sexual Assault Nurse Examiners (ACC‐SANE) program was developed to respond to the needs of sexual assault victims. Although this type of SANE model allows for a strong nurse‐managed program, there are frustrations and pitfalls that differ from most hospital‐based programs. At this time, the majority (71%) of SANE programs are based in hospitals, and few (15%) function in outpatient/community facilities. In the ACC‐SANE program, many community agencies interact to provide a seamless approach to postassault health care, counseling, and criminal prosecution. SANE nurses are well equipped to provide forensic examinations in a caring, out‐of‐hospital environment. The program is housed in a remodeled cottage that rests on property owned by the Athens‐Clarke County government and that is adjacent to the local police department. ACC‐SANE is governed by a nonprofit board of directors. This management model has allowed the original organizing groups to remain active in the development of the program. As these agencies continue in the governance of the program, they remain committed to the success of ACC‐SANE. The impact of program growth and published program guidelines is examined.
Assessment of Community Contamination: A Critical Approach
Authors: Clark Lauren , Barton Judith A. , Brown Nancy J.
Published: March 2003

The purpose of this paper is to review data from two Superfund sites and describe the latitude of interpretation of “environmental risk” by residents living in the area, governmental agencies, and the media. The first community was located within a 5‐mi perimeter of the Rocky Flats Environmental Technology Site (RFETS) outside Denver, Colorado. The second community was located on the south side of Tucson, Arizona, adjacent to the Tucson International Airport area (TIAA) Superfund site. Critical theory was the perspective used in this analysis and proposal of public health actions to attain social justice. Differences between the two populations' experiences with risk and contamination coincided with divergent levels of trust in government. RFETS residents demanded monitoring, whereas the minority residents at TIAA were ambivalent about their trust in government cleanup activities. Unraveling the purpose of “facts” and the social force of “truth” can direct nurses to address environmental justice issues. By policing governmental and business activities in halting or cleaning up environmental contamination, nurses may become mouthpieces for the concerns underlying the fragile surface of “virtual trust” in contaminated communities. Cutting through competing rhetoric to police environmental safety, the core function of assurance becomes what nurses do, not what they say.
Selected Factors Associated with Students' Perceptions of Threat in the Community
Authors: Morin Karen H. , Hayes Evelyn R. , Carroll Mary , Chamberlain Barbara
Published: March 2003

Abstract This study assessed nursing students' perceptions of threat in the community from the beginning to the completion of their first formal community health nursing course (inclusive of specific community health content associated with relevant clinical experience) and determined how perceptions of threat differed by residential zone and by type of program (generic day, generic weekend/evening, or R.N.). Undergraduate nursing students were sampled from eight National League for Nursing Accrediting Commission (NLNAC) accredited baccalaureate schools. Completed pretest data were obtained for 345 students. Completed post‐test data were obtained for 274 students. Paired data were available for 197 students.

 Generally, students were comfortable when the environment was assessed within the context of daylight before and after the course. Students were not as comfortable with the environment when assessed within the context of nighttime either before they started the community course or after they completed it.

 Students continue to perceive that the community environment presents limited threats, particularly when viewed from the perspective of time of day. Because the community educational experience is not restricted to baccalaureate education (Cahill et al., 1998), nor is it conceptualized as a singular experience (Mellon & Nelson, 1998), the challenge to faculty is to enhance student learning by preparing them in such a manner that they assess their community environment for threats and practice safely within that environment. The use of the Environmental Comfort Scale III, including the open‐ended question, may be one way to achieve this challenge.
Accessory Scrotum: An Unusual Localization of Scrotal Skin
Authors: Korkmaz Ayşe , Tekinalp Gülsevin , Aygün Canan , Şahin Sedef
Published: March 2003

Accessory scrotum is an extremely rare congenital scrotal anomaly defined as the occurrence of scrotal skin outside of its proper location with no testicular tissue. We report a preterm twin male infant who had an accessory scrotum located on the right inguinal and proximal femoral region.
Wegener Granulomatosis in a Child: Cutaneous Findings as the Presenting Signs
Authors: Brazzelli V. , Vassallo C. , Baldini F. , Ravelli A. , Martini A. , Borroni G.
Published: March 2003

Abstract: Wegener granulomatosis (WG) is a systemic disease that is particularly unusual in children. A limited form has been described without renal involvement. We report a 14‐year‐old girl in whom the disease started with acneiform nodular and papular lesions on the forehead. Later necrotic ulcers developed on her forehead, arms, and buttocks. The cutaneous lesions were associated with upper and lower respiratory tract involvement, low‐grade fever and arthralgias. Subsequently clinical and laboratory evaluations (increased ESR; leukocytosis and presence of serum IgG antibodies cANCA = 1:160), with chest roentgenograms revealing pulmonary densities and parenchymal infiltration, suggested the diagnosis of WG. The histologic findings of a cutaneous biopsy specimen were ulceration of the epidermis with diffuse neutrophilic inflammatory infiltrate and a late‐stage small vessel vasculitis in the dermis. Histopathology of the nasal mucosa was characterized by a granulomatous process with a dense lymphohistiocytic infiltrate with few giant cells, a finding that confirmed the diagnosis of WG. No renal involvement was present. One month of cyclophosphamide (125 mg/day) and prednisone (70 mg/day) therapy markedly improved the patient's clinical condition. At present, 1 year later, she is free from any signs of the disease. According to the literature, the frequency of cutaneous lesions in WG ranges from 16% to 46%. They are the presenting sign only in 6% of patients. Cutaneous lesions are even more uncommon in children. In particular, an “acneiform” presentation is a rare finding in WG.
Familial Multiple Basaloid Follicular Hamartomas: A Report of Two Affected Sisters
Authors: Girardi Michael , Federman Grace L. , McNiff Jennifer M.
Published: March 2003

Abstract: Basaloid follicular hamartoma (BFH) is one of several benign skin tumors that may occur in multiple and solitary forms. While the histologic findings of BFH may be observed in a variety of clinical settings, familial multiple BFH represents a distinct clinical entity characterized by tiny flesh‐colored papules scattered predominantly over the face. We present two sisters with this rare condition and review the clinical and histologic differential diagnosis of familial multiple BFH.
Radius Hypoplasia, Radial Palsy, and Aplasia Cutis Due to Amniotic Band Syndrome
Authors: Nagore Eduardo , Sánchez‐Motilla José M. , Febrer M. Isabel , Cremades Beatriz , Aleu Montserrat , Aliaga Adolfo
Published: March 2003

Amniotic band syndrome is one of the many causes of aplasia cutis congenita. It is usually seen as a constriction band surrounding a limb or as a membrane that adheres to some part of the body. This syndrome can be associated with various malformations. An infant with amniotic adhesions producing aplasia cutis, radial palsy, and hypoplasia of the radius is presented. Early treatment led to total functional recovery of the affected limb.
Multiple Granular Cell Tumors and Growth Hormone Deficiency in a Child
Authors: Seiter Simone , Ugurel Selma , Tilgen Wolfgang , Reinhold Uwe
Published: March 2003

Abstract: Granular cell tumor is an uncommon benign tumor occurring on the skin as a single nodule. Multiple tumors are very rare, particularly in children. We describe a child with multiple granular cell tumors on the skin in association with growth hormone deficiency. The occurrence of multiple granular cell tumors in association with other clinical manifestations in childhood is discussed.