bluuebunny/crossref_metadata_2025 huggingface dataset:
European leadership in cultural synergy
Authors: Harris Philip R.
Published: August 2004

This paper explains the concept of cultural synergy and provides a contrast of societies that could be characterized as having high or low synergy, as well as organizational culture that reflects high and low synergy. Within organizations, the research insights reported here center on behaviors and practices that contribute to synergy and success among teams, particularly in terms of international projects. The concluding section describes people who are truly “professionals” in their attitude toward their career and work, and how they can mutually benefit from the practice of synergy. Real European leaders actively create a better future through synergistic efforts with fellow professionals. The knowledge work culture favors cooperation, alliances, and partnership, not excessive individualist actions and competition. This trend is evident, as well as necessary, in corporations and industries, in government and academic institutions, in non‐profit agencies and unions, in trade and professional associations of all types. In an information or knowledge society, collaboration in sharing ideas and insights is the key to survival, problem solving, and growth. But high synergy behavior must be cultivated in personnel, so we need to use research findings, such as those outlined in this paper, to facilitate teamwork and ensure professional synergy. In addition to fostering such learning in our formal education and training systems, we also should take advantage of the increasing capabilities offered to us for both personal and electronic networking. Contemporary global leaders, then, seek to be effective bridge builders between the cultural realities or worlds of both past and future. Cultivating a synergistic mind‐set accelerates this process.
The expansion of the EMU: currency speculation and arbitrage
Authors: Ghannadian Farhad F.
Published: August 2004

The latest European Union summit in the fall of 2002 revealed that over 11 countries (Cyprus, The Czech Republic, Estonia, Hungary, Latvia, Malta, Poland, Slovakia, Slovenia, Bulgaria, and Romania) have expressed their desire to join the European Monetary Union (EMU) and convert their currency to the “euro”. The European Commission will have to completely equalize interest rates and inflation rates of all these countries before admitting them to join the EMU or there will be arbitrage profits and currency speculation, which will slow down the growth of the overall European Community and negatively affect the value of the euro.
Is globalization consistent with the accumulation of FDI inflows in the Balkan countries?
Authors: Bitzenis Aristidis
Published: August 2004

Most large enterprises have “a global view” in the expansion of their activities and, thus, in the creation of their investment projects. They invest in specific countries when they conclude that the countries in question fulfill their goals. It is not enough that an economy of a country has as a target to become a market economy, to open its borders and to attract foreign direct investment (FDI) flows for the economy to become globalized, but it is necessary for this result to be shown by significant foreign participation and huge FDI and trade inflows into the host country. If this never happens, then the country will not benefit from globalization. From one point of view, multinational enterprises (MNEs) “decide” which countries benefit from economic integration and which countries successfully participate in the huge worldwide globalized economic chain. On the other hand, due to the large investment opportunities that a few countries offer to MNEs and due to the large number of host countries, at the end, MNEs invest only in specific countries. Thus, there are a lot of countries that are isolated from the whole system. Moreover, smaller MNEs in economic magnitude often extend their activities mainly to neighboring countries, in order to maximize their profits and minimize their costs. The share of FDI is not the same in all countries and the FDI inflows in less‐developing or poor countries show little growth or no growth at all. Today's FDI orientation is not as global as expected and there is a regional trend in those flows, when at the same time a few countries, especially from specific regions (such as the Balkan region) still live cut off from the world of FDI flows.
Arsenic mitigation and social mobilisation in Bangladesh
Authors: Rammelt Crelis F. , Boes Jan
Published: August 2004

For the people of Bangladesh, mostly in rural areas, a new disaster is emerging. Two‐thirds of the deep tube wells installed over the last three decades – roughly 3 million in total – contain arsenic concentrations above the permissible levels set by the WHO. These wells were installed to contribute to a secure and reliable drinking water supply, and put an end to various contagious diseases from the use of surface water. In itself that goal has been reached. It is therefore a bitter observation that it is this very approach that has led to the widespread arsenic poisoning of drinking water. Most rural development programs cannot meet the demand of the community because of the absence of appropriate institutional mechanisms, and most programs simply cannot reach the large low‐income groups. It is time to rethink the existing institutional set‐up and redefine the roles of communities, the private sector, NGOs, local government institutions and the central government. An initiative from several Bangladeshi organisations has resulted in international co‐operation – the Arsenic Mitigation and Research Foundation (AMRF). Participation of the local community is one of the guiding principles of AMRF. Local priorities will be a significant component in the decisions made regarding mitigation activities. Given the institutional weakness of governmental bodies in solving problems within a reasonable time, it is natural to look for local solutions based on local experience, knowledge and capacity. Focuses on institutional development and community participation related to arsenic contamination in drinking water and broadly in sustainable development policy and practice in Bangladesh. Looks into possible comprehensive frameworks for the implementation of sustainable drinking water systems, facilitating a basic development strategy for people's participation. Discusses ways to ensure a greater role for the community in achieving a sustainable rural water management system, involving formal institutions as well as informal networks at village community level.
Expression of Na+/HCO3− co‐transporter proteins (NBCs) in rat and human skeletal muscle
Authors: Kristensen J. M. , Kristensen M. , Juel C.
Published: August 2004

Aim:  Sodium/bicarbonate co‐transport (NBC) has been suggested to have a role in muscle pH regulation. We investigated the presence of NBC proteins in rat and human muscle samples and the fibre type distribution of the identified NBCs.

Methods and results:  Western blotting of muscle homogenates and sarcolemmal membranes (sarcolemmal giant vesicles) were used to screen for the presence of NBCs. Immunohistochemistry was used for the subcellular localization. The functional test revealed that approximately half of the pH recovery in sarcolemmal vesicles produced from rat muscle is mediated by bicarbonate‐dependent transport. This indicates that the NBCs are preserved in the vesicles. The western blotting experiments demonstrated the existence of at least two NBC proteins in skeletal muscle. One NBC protein (approximately 150 kDa) seems to be related to the kidney/pancreas/heart isoform NBC1, whereas the other protein (approximately 200 kDa) is related to the NBC4 isoform. The two NBC proteins represent the electrogenic isoforms named NBCe1 and NBCe2. Membrane fractionation and immunofluorescence techniques confirmed that the two NBCs are located in the sarcolemmal membrane as well as in some internal membranes, probably the T‐tubules. The two NBCs localized in muscle have distinct fibre type distributions.

Conclusions:  Skeletal muscle possesses two variants of the sodium/bicarbonate co‐transporter (NBC) isoforms, which have been called NBCe1 and NBCe2.
Extracellular GABA in the medial hypothalamus is increased following hypocretin‐1 administration
Authors: Viggiano An. , Monda M. , Viggiano Al. , Fuccio F. , De Luca B.
Published: August 2004

Aim: Hypocretin 1 is an hypothalamic neuropeptide that induces an increase in food intake when administered into the cerebral lateral ventricle. As it is well known that the medial hypothalamus (MH) is involved in the feeding behaviour also through GABAergic circuits, the aim of this experiment was to investigate the effect of an hypocretin 1 intracerebroventricular (icv) injection on the extracellular levels of GABA in the MH.

Methods: GABA levels in the MH were evaluated in six rats by microdialysis and high performance liquid chromatography‐electrochemical detection 30 min before and every 30 min for an over all period of 6 h after an icv injection of hypocretin 1. The same procedure was used in another group of six rats but saline was injected into the lateral ventricle as control.

Results: The results show that extracellular GABA increases in the MH after the injection of hypocretin 1 at 60 min and at 3 h after the injection.

Conclusion: This finding suggests a possible mechanism by which hypocretin 1 should induce hyperphagia in the first hour after injection. As it is already known that the inhibition of the MH by injection of GABA causes an increase of food intake, it is possible that hypocretin 1 causes an increase in food intake by increasing the GABA release in the MH. The lack of an increase in the GABA level after the fourth hour is consistent with the lack of an increase in food intake at this time, as we observed in previous experiments. The finding of a biphasic increase in the GABA level, at 60 min and at 3 h, was unexpected and should be further investigated.
Effect of pitavastatin against expression of S100β protein in the gerbil hippocampus after transient cerebral ischaemia
Authors: Muramatsu Y. , Kurosaki R. , Kato H. , Araki T.
Published: August 2004

Aim and methods:  We investigated the immunohistochemical alterations of S100β‐, S100‐, glial fibrillary acidic protein (GFAP)‐ and isolectin B4‐positive cells in the hippocampus after 5 min of transient cerebral ischaemia in gerbils. We also examined the effect of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A (HMG‐CoA) reductase inhibitor pitavastatin against neuronal damage in the hippocampal CA1 sector after ischaemia.

Results:  Severe neuronal damage was observed in the hippocampal CA1 pyramidal neurons from 5 days after ischaemia. GFAP‐positive cells increased gradually in the hippocampus from 5 days after ischaemia. Five and 14 days after ischaemia, significant increases in the number of GFAP‐positive cells and isolectin B4‐positive cells were observed in the hippocampal CA1 and CA3 sector. Mild increases in the number of S100 and S100β‐positive cells were observed in the hippocampal CA1 sector from 1 h to 2 days after ischaemia. Thereafter, S100β‐positive cells increased in the hippocampal CA1 sector after ischaemia, whereas S100‐positive cells decreased in this region. In our double‐labelled immunostainings, S100 and S100β immunoreactivity was found in GFAP‐positive astrocytes, but not in isolectin B4‐positive microglia. Pharmacological study showed that HMG‐CoA reductase inhibitor, pitavastatin, can protect against the hippocampal CA1 neuronal damage after ischaemia. This drug also prevented increases in the number of GFAP‐positive astrocytes, isolectin B4‐positive microglia, S100‐positive astrocytes and S100β‐positive astrocytes after ischaemia.

Conclusion:  The present study demonstrates that pitavastatin can decrease the neuronal damage of hippocampal CA1 sector after ischaemia. This beneficial effect may be, at least in part, mediated by inhibiting the expression of astrocytic activation in the hippocampus at the acute phase after ischaemia. Thus the modulation of astrocytic activation may offer a novel therapeutic strategy of ischaemic brain damage.
DNA hypo‐methylating agents and sickle cell disease
Authors: Saunthararajah Yogen , Lavelle Donald , DeSimone Joseph
Published: August 2004

Fetal haemoglobin (HbF, α2) decreases polymerization of sickle haemoglobin (HbS) and high levels correlate with decreased morbidity and mortality in sickle cell disease (SSD). Therefore, a therapeutic goal in SSD is the pharmacologic reactivation of HbF. Silencing of the globin (HbF) gene is associated with DNA methylation. The cytosine analogues 5‐azacytidine and 5‐aza‐2′‐deoxycytidine (decitabine) hypomethylate DNA by inhibiting DNA methyl‐transferase. In clinical trials, 5‐azacytidine and decitabine have demonstrated the greatest efficacy in HbF reactivation. Clinical development of these drugs has been delayed by concerns regarding the carcinogenic potential of 5‐azacytidine. Furthermore, controversy regarding DNA hypomethylation versus more generic cytotoxic effects as the mechanism of action suggested that other cytotoxic/cytostatic agents might be as effective. Additional preclinical data and clinical studies of decitabine have tempered many safety concerns and have confirmed that DNA hypomethylation is the mechanism of action. Pharmacologic reactivation of HbF through DNA hypomethylation holds promise as an effective disease modifying intervention for patients with SSD. Larger studies are required to confirm safety and effectiveness with chronic use.
Differing body size between the autumn and the winter–spring cohorts of neon flying squid (Ommastrephes bartramii) related to the oceanographic regime in the North Pacific: a hypothesis
Authors: Ichii Taro , Mahapatra Kedarnath , Sakai Mitsuo , Inagake Denzo , Okada Yoshihiro
Published: August 2004

The neon flying squid (Ommastrephes bartramii), which is the target of an important North Pacific fishery, is comprised of an autumn and winter–spring cohort. During summer, there is a clear separation of mantle length (ML) between the autumn (ML range: 38–46 cm) and the winter–spring cohorts (ML range: 16–28 cm) despite their apparently contiguous hatching periods. We examined oceanic conditions associated with spawning/nursery and northward migration habitats of the two different‐sized cohorts. The seasonal meridional movement of the sea surface temperature (SST) range at which spawning is thought to occur (21–25°C) indicates that the spawning ground occurs farther north during autumn (28–34°N) than winter–spring (20–28°N). The autumn spawning ground coincides with the Subtropical Frontal Zone (STFZ), characterized by enhanced productivity in winter because of its close proximity to the Transition Zone Chlorophyll Front (TZCF), which move south to the STFZ from the Subarctic Boundary. Hence this area is thought to become a food‐rich nursery ground in winter. The winter–spring spawning ground, on the other hand, coincides with the Subtropical Domain, which is less productive throughout the year. Furthermore, as the TZCF and SST front migrate northward in spring and summer, the autumn cohort has the advantage of being in the SST front and productive area north of the chlorophyll front, whereas the winter–spring cohort remains to the south in a less productive area. Thus, the autumn cohort can utilize a food‐rich habitat from winter through summer, which, we hypothesize, causes its members to grow larger than those in the winter–spring cohort in summer.
Somatic energy of sockeye salmon Oncorhynchus nerka at the onset of upriver migration: a comparison among ocean climate regimes
Authors: Crossin Glenn T. , Hinch Scott G. , Farrell Anthony P. , Higgs David A. , Healey Michael C.
Published: August 2004

We examined somatic energy patterns in two stocks (Chilko and Early Stuart) of adult Fraser River (British Columbia, Canada) sockeye salmon (Oncorhynchus nerka), collected at the end of their ocean residency, spanning years across different climate regimes. Both stocks had high levels of somatic energy in years with high open ocean productivity (1956, 1957, 2001 and 2002), and relatively low levels in years with poor open ocean productivity (1999 and 2000). For Early Stuart sockeye, energy levels in 1999 and 2000 were approximately 15% lower (∼1.5 MJ kg−1) than that in the 1950s, an amount of energy equivalent to that necessary for migrating 600 km upriver. In recent years (2001 and 2002), energy levels have increased by about 9% for both stocks. Low energy levels at the onset of upriver migration, particularly in years of energetically demanding in‐river conditions, such as high flows or temperatures, are likely to contribute to prespawning and en route mortality in Fraser sockeye.
Melanotic neuroectodermal tumour of infancy in the maxilla: a case report
Authors: LIU H.‐H. , CHEN T.‐W. , CHANG H.‐S.
Published: August 2004

Summary. A 4·5‐month‐old Chinese boy presented with a bulging mass in the anterior right maxillary region. Clinical features and incisional biopsy examination confirmed the diagnosis of melanotic neuroectodermal tumour of infancy (MNTI). The lesion had first been noted a month before the biopsy. The extent of the lesion was defined via computed tomography, and surgical excision was accomplished through a partial maxillectomy under general anaesthesia. The patient has been irregularly followed‐up over the past 8 years, and no evidence of recurrence has been found, either by clinical examination or serial computed tomography scans. A bony defect and a lack of alveolar process were noted on the right side of the anterior maxilla. The patient displayed social withdrawal at school as a result of his partial anodontia. There have only been a limited number of reports on the dental rehabilitation of postoperative MNTI. We report a case of maxillary MNTI in which the need for dental rehabilitation was emphasized.
Social inequalities in oral health and in use of oral health care services among adolescents in Uganda
Authors: OKULLO I. , ÅSTRØM A. N. , HAUGEJORDEN O.
Published: August 2004

Objective. The aim of this study was to describe clinical and self‐perceived indicators of oral health status and the use of oral health care services by social and demographic characteristics.

Methods. In 2001, a cross‐sectional random sample survey was conducted in urban and rural settings in Uganda (Kampala and Lira, respectively), and 1146 secondary school students with a mean age of 15·8 years completed questionnaires in school. Dental caries was recorded by one examiner on a random subsample of 372 students.

Results. Logistic regression analyses revealed that being an urban resident was associated with higher odds for having dental caries (dmft > 0), seeking care because of toothache (delayed treatment demand) and being dissatisfied with one's own oral health status [adjusted odds ratio (OR) = 1·5–2·1]. Being an urban resident was associated with lower odds for oral health care attendance generally and for having missing teeth in particular (adjusted OR = 0·6–0·4). Students who had parents with a higher education and those with weak social ties were, respectively, less and more likely to be dissatisfied with their oral health status. As compared to caries‐free participants, the odds for being dissatisfied with oral health and delayed treatment demand increased significantly with an increasing dmft score (adjusted OR = 2·1–3·2).

Conclusion. Urban students were most likely to have a dmft > 0 and to rate their oral health status negatively. Having received dental care and the prevalence of missing teeth, and delayed treatment demand were, respectively, most and least prevalent among rural students. Dental caries at different diagnostic cut‐off points and weak social ties affected self‐reported oral health negatively, independently of social and demographic characteristics.
Species composition and abundance of aphids in Australian hop gardens and their impact on spatiotemporal patterns of Carlavirus epidemics
Authors: Pethybridge S. J. , Madden L. V. , Griggs J. , Wilson C. R.
Published: August 2004

The species composition and abundance of aphids in commercial cv. Agate and cv. Super Pride hop gardens in Tasmania, Australia, were characterized over three seasons (1999–2001). Gunns Plains recorded 14 aphid species and Bushy Park 11 species, with nine of these common to both sites. The majority of aphids were trapped in the first 2 months (October and November) of active hop growth in all three seasons. Cultivar and geographical location had significant effects on the abundance of total aphids (species pooled) trapped and several individual aphid species in the three seasons. In general, significantly more aphids (total and individual species) were trapped in cv. Agate than cv. Super Pride gardens, and higher numbers were trapped at Bushy Park than at Gunns Plains. This coincided with a higher incidence of plants infected by carlaviruses in cv. Agate gardens at both locations. Differences in the spatiotemporal dynamics of Carlavirus epidemics were described by fitting a stochastic model to the data, with parameters for local spread within the garden (contagion) and background infection (disease increase unrelated to infected plants within the gardens). Local spread of Hop latent virus (HpLV) and Hop mosaic virus (HpMV) was indicated within all gardens. For HpMV in cv. Agate at Gunns Plains, however, infections caused by immigrant viruliferous aphids were also apparent. Using join‐count statistics, spatial aggregation of both virus diseases was found for all years, except for the initial year (1999) when incidence was low. Clusters of diseased plants extended to greater distances for HpLV than for HpMV. Based on spatial and spatiotemporal analyses, local spread (mechanical transmission and/or aphid movement within the garden) appears to be the dominant factor in the epidemics of HpLV. Aphid immigration from outside the crop over time may play a more significant role for HpMV epidemics, at least for one location.
‘From the sphere of Sarah Gampism’: the professionalisation of nursing and midwifery in the Colony of Victoria
Authors: Grehan Madonna
Published: August 2004

In the nineteenth century, while the Colony of Victoria was still a fledgling settlement, many of the hospitals of England, Scotland, Ireland, and Europe had instituted forms of nursing and midwifery training. When graduates of these training schemes emigrated to Australia with their knowledge, skills and experience, they found health practice to be haphazard and lacking in organisational standards. Individual immigrant women rose to prominence as managers of Victorian hospitals, and superintendents of homes for trained nurses. Through professional networks of their peers and compatriots, these women succeeded in placing the profession of nursing on a firm footing, and were instrumental in the emergence of professional organisations for trained nurses and midwives in Victoria, including the Melbourne District Nursing Society, the short–lived Nurses Association of Australasia (1892), and the Victorian Trained Nurses Association (1901). Their leadership was to have a profound influence on the way nursing and midwifery were regulated in twentieth century Victoria. In this historical review, we trace the movement to professionalise nursing and midwifery which emerged in the Colony of Victoria during the late nineteenth and early twentieth centuries.
How one could once become a registered nurse in the United States without going to a hospital training school
Authors: Bullough Vern L
Published: August 2004

Distant learning in nursing is both a new and old concept. This paper examines an early example of correspondence schools in nursing, namely the Chautauqua School which over the course of its existence enrolled over 20 000 students. Its closing was due in large part to the opposition of organized nursing which had become institutionalized in the hospital training school. It was not until the 1990's when license recertification was required that long distant nursing again assumed importance.
Tracheal agenesis: management of the first 10 months of life
Authors: Baroncini‐Cornea S. , Fae M. , Gargiulo G. , Gentili A. , Lima M. , Pigna A. , Pilu G. , Tancredi S. , Turci G.
Published: August 2004

Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare‐associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life.
Airway management during an EXIT procedure for a fetus with dysgnathia complex
Authors: Baker Paul A , Aftimos Salim , Anderson Brian J
Published: August 2004

Nonsyndromal dysgnathia is a rare disorder with a probable genetic basis characterized by a hypoplastic or absent mandible (agnathia), microstomia, microglossia, and ear anomalies secondary to a defect in the ventral portion of the first branchial arch caused by defective neural crest migration or proliferation. Dysgnathic newborn infants often suffer fatal respiratory failure from airway obstruction. Nineteen children with isolated dysgnathia complex are described in the literature – six were stillborn, eight died shortly after birth, and only five survived infancy. All survivors required tracheostomy to maintain an airway. It is difficult to intubate the trachea of these children and early airway management planning is important. We report a neonate who presented with a prenatal ultrasound diagnosis of severe micrognathia, polyhydramnios and a family history of severe micrognathia. Airway management was achieved with fiberoptic intubation through a laryngeal mask airway (LMATM) during an ex utero intrapartum treatment procedure. Fiberoptic intubation was hampered by copious amounts of amniotic fluid. This child and her sibling are the first two siblings with isolated dysgnathia complex to have survived infancy and provide further support for a genetic basis to this condition.
Is tissue coring a real problem after caudal injection in children
Authors: Baris Sibel , Guldogus Fuat , Baris Yakup Sancar , Karakaya Deniz , Kelsaka Ebru
Published: August 2004

Background : The aim of this study was to determine whether tissue coring occurs with 22‐G hollow needle and 22‐G caudal block needle during caudal injection in children, as well as evaluating the nature of the coring material if it did occur.

Methods : Seventy children were randomly allocated to two groups and caudal block was performed with either 22‐G hollow (group I) or 22‐G caudal block (group II) needle under general anesthesia. The needles and guides were washed with 0.5 ml of 70% ethanol in a sterile tube and were evaluated by a pathologist blinded to the type of needle used, for the type and number of cells.

Results : Nucleated cells, which have no mitotic activity, were present in 8.5% in each study group and bloody material was present in 8.5 and 2.8%, in group I and II, respectively. Non‐nucleated epidermal cells were detected in 94.2 and 97.1% of the patients in group I and II, respectively. However, cells with mitotic activity from the stratum basale were not detected in any slides.

Conclusions : The incidence of transporting nucleated epidermal cells with no mitotic activity from stratum spinosum during puncture for caudal block is low and no differences exist between different types of needle used. However, it may also suggest that transporting nucleated cells with mitotic activity from the stratum basale may be possible during caudal puncture.
Jet injector compared with oral midazolam for preoperative sedation in children
Authors: Fine Brad , Castillo Rose , McDonald Tim , Paisansathan Chanannait , Zsigmond Elemer , Hoffman William E.
Published: August 2004

Background : This study compared onset of sedation and satisfaction with two needleless jet injectors with the oral route for the administration of midazolam.

Methods : Forty‐five children ages 1–6 years were randomly assigned to receive either 0.5 mg kg−1 oral midazolam, 0.2 mg kg−1 subcutaneous midazolam by J‐Tip injector or 0.2 mg kg−1 intramuscular midazolam by Bioject injector. After midazolam administration the children were monitored for oxygen saturation, heart rate and level of sedation (0, alert; 1, calm; 2, drowsy; 3, dozing; 4, asleep) every 2 min for 20 min by a physician blinded to the route of administration. Patient satisfaction, resistance to treatment, success of delivery, problems with separation, and acceptance of mask at the time of induction were evaluated after midazolam treatment.

Results : The Bioject showed a faster onset of sedation than either the J‐Tip injector or the oral midazolam (P < 0.05). The children were significantly less satisfied with the Bioject and J‐Tip administration vs oral midazolam (P < 0.05). There were no differences in resistance, success of delivery, problems with separation, mask acceptance, arterial oxygen saturation or heart rate.

Conclusion : Despite children being less satisfied with Bioject injection of midazolam, the procedure is safe, effective and provides a more rapid onset of preoperative sedation in children than either the J‐Tip injection or oral route.
The Effects of State Mental Health Parity Legislation on Perceived Quality of Insurance Coverage, Perceived Access to Care, and Use of Mental Health Specialty Care
Authors: Bao Yuhua , Sturm Roland
Published: August 2004

Objective. To assess the impacts of recent state mental health parity legislation on perceived quality of health insurance coverage, perceived access to needed health care, and use of mental health specialty services by individuals with likely need for mental health care.

Data Sources. The study sample came from two waves of a national household survey first fielded in 1997–1998 and then in 2000–2001. The analysis used a subset of the sample.

Study Design. The study took the Difference‐in‐Difference‐in‐Difference approach to investigate changes in self‐perceived quality of health insurance coverage and access to needed health care, and use of mental health specialty care by the group with mental disorders (relative to those without) in states with parity legislation of different comprehensiveness (relative to the nonparity states) in the years after the law (relative to before the law).

Principal Findings. Overall, there were no significant or consistent effects of the parity legislation. Descriptive statistics showed significant changes in some (but not all) outcome variables, but these results disappeared in detailed statistical analyses by controlling for important covariates.

Conclusions. The null findings of the effects of state mental health parity mandates suggest that under ERISA (Employee Retirement Income Security Act), the scope of state parity legislation may have been restricted because of large proportion of self‐insured employers. Furthermore, comprehensiveness of state legislation appears to be related to the traditional level of use of mental health specialty care, which becomes another confounder for the potential policy effects.
Monitoring Visual Status: Why Patients Do or Do Not Comply with Practice Guidelines
Authors: Sloan Frank A. , Brown Derek S. , Carlisle Emily Streyer , Picone Gabriel A. , Lee Paul P.
Published: August 2004

Objective. To determine factors affecting compliance with guidelines for annual eye examinations for persons diagnosed with diabetes mellitus (DM) or age‐related macular degeneration (ARMD).

Data Sources/Study Setting. Nationally representative, longitudinal sample of individuals 65+ drawn from the National Long‐Term Care Survey (NLTCS) with linked Medicare claims records from 1991 to 1999.

Study Design. Medicare beneficiaries were followed from 1991 to 1999, unless mortality intervened. All claims data were analyzed for presence of ICD‐9 codes indicating diagnosis of DM or ARMD and the performance of eye exams. The dependent variable was a binary indicator for whether a person had an eye exam or not during a 15‐month period. Independent variables for demographics, living conditions, supplemental insurance, income, and other factors affecting the marginal cost and benefit of an eye exam were assessed to determine reasons for noncompliance.

Data Collection/Extraction Methods. Panel data were created from claims files, 1991–1999, merged with data from the NLTCS.

Principal Findings. The probability of having an exam reflected perceived benefits, which vary by patient characteristics (e.g., education, no dementia), and factors associated with the ease of visit. African Americans were much less likely to be examined than were whites.

Conclusions. Having an exam reflects multiple factors. However, much of the variation in the probability of an exam remained unexplained as were reasons for the racial differences in use.
Nursing‐Sensitive Outcome Implementation and Reliability Testing in a Tertiary Care Setting
Authors: Behrenbeck Julia G.
Published: August 2004

PURPOSE

To describe the NOC outcomes most relevant for specialty nursing practice and in selected field sites representing the continuum of care; to assess the adequacy of measures (reliability, validity, sensitivity, specificity, practicality); and to describe the linkages among nursing diagnoses, interventions, and outcomes in clinical decision making.

METHODS

Data were collected on 434 patients during the 12‐month data collection period at a tertiary care center: cardiac surgery intensive care (n= 76), cardiac transplant unit (n= 153), and medical unit (n= 205). Medical diagnoses of patients on the two cardiac units were related to cardiac disease. Medical diagnoses of patients on the medical unit were extremely varied (ranging from e.g., gout to pneumonia). Data were collected on 65 separate outcome labels for a total of 633 ratings.

FINDINGS

In the cardiac transplant ICU, data were collected on 42 outcomes: 30 had an average interrater reliability of ≥85%, and 16 had an absolute agreement interrater reliability of ≥85%. In the cardiac surgery ICU, data were collected on 30 outcomes: 25 had an average interrater reliabilty of ≥85%, 6 had an absolute agreement interrater of ≥85%. In the medical unit, data were collected on 45 outcomes: 41 had an average interrater reliability of ≥85%, 14 had an absolute agreement interrater reliability of ≥85%. Four outcomes have been implemented into the documentation system for all patients: Tissue Integrity: Skin and Mucous Membranes, Mobility Level, Knowledge: Disease Process, and Coping.

CONCLUSIONS

Overall, nursing staff were very positive about having the opportunity to participate in nursing research. Staff were able to think about the relative status of their patient and how nursing care contributes to the patient's recovery. They appreciated the opportunity to discuss this with a colleague during the interrater exercise. Increased familiarity with NOC allows staff members to determine which outcomes comprise core nursing‐sensitive outcomes for their clinical setting.
Transcultural Adaptation of NANDA Taxonomy II to a Brazilian Context
Authors: Marlene Michel Jeanne Liliane , Botura Leite de Barros Alba Lucia
Published: August 2004

PURPOSE

To translate NANDA Taxonomy II into Brazilian Portuguese.

METHODS

Semantic equivalence was obtained through a process of translation and back translation, supervised by a professor (RN and PhD) expert in using nursing diagnoses taxonomy both in teaching and in clinical practice. Conceptual equivalence was attained by presenting the original text, the translation and the back translation of the labels, definitions, defining characteristics or risk factors, and related factors to a group of expert nurses from different specialties who are proficient in English in order to analyze them and to verify if the terms presented in each diagnosis are suitable to the Brazilian nurses' practice reality, making suggestions as appropriate. The results of this analysis and the suggestions were then discussed by a committee with expertise in this kind of work and nursing diagnosis until consensus could be reached.

FINDINGS

Some difficulties were found in the translation process because of the structural differences between English and Portuguese, and also because many diagnostic concepts are presented in different ways in the book. With the Portuguese translation, trouble occurs because of alphabetical order. Even if this is only a matter of organization, when discussing which one could be the correct form of these diagnostic concepts, a more important question emerged: What really composes the concept? We believe the concept is general, and should not contain components from the other axes. For instance, we think incontinence is better than bowel incontinence, because “bowel” is on the axis topology. We await a response from NANDA in order to continue the work.

CONCLUSIONS

Providing Brazilian nurses with NANDA Taxonomy II adapted to Brazilian nursing practice will allow them to continue clinical application of this classification, as well as develop research projects.
Translation of Books about Nursing Diagnosis: Experience of Technical Proofreaders From the South of Brazil
Authors: Almeida Miriam de Abreu , Soares Maria Augusta , Unicovsky Margarita Rubin , Valéria Giordani Araújo
Published: August 2004

BACKGROUND

In Brazil, nursing diagnosis appeared as a step in the nursing process in the late 1970s. In the late 1980s studies were initiated following an exchange between a group of professors from Federal University of Para Connecticut. In the 1990s literature began to appear that took into consideration nursing diagnoses, mainly in translated books.

MAIN CONTENT POINTS

The main steps in the translation of books are translation of the original text into Portuguese, proofreading, technical proofreading, and a final reading. The technical proofreaders change parts of the text that do not correspond with the ideas and the style of the authors or that cannot be well understood by the final reader; revise technical terms, concepts, and description of procedures; correct possible failures in the translation because of a lack of technical knowledge; adapt information to the Brazilian situation; and add notes to clarify the ideas of the author, using footnotes.

The original books we have translated include Handbook of Nursing Diagnosis, 6th ed. (Carpenito, 1995); Nurse's Pocket Guide: Nursing Diagnoses With Interventions, 5th ed. (Moorhouse & Doenges, 1996); Nursing Care Plans and Documentation: Nursing Diagnoses and Collaborative Problems, 2nd ed. (Carpenito, 1995); Applying Nursing Process: A Step‐by‐Step Guide, 4th ed. (Alfaro‐LeFevre, 1998); Handbook of Nursing Diagnosis, 8th ed. (Carpenito, 1999); and Nursing Diagnosis: Application to Clinical Practice, 8th ed. (Carpenito, 2000).

Proofreading is a pleasant and rewarding activity. It provides closer contact with the authors, an opportunity to be in touch with the scientific knowledge and the English language, a way of being in touch with current literature, professional growth, and the exchange of experiences.

The difficulties encountered included adaptation from the North American to the Brazilian situation (some terms cannot be translated because of the differences between the languages), the existence of nursing diagnoses that do not apply to the Brazilian situation, too many proofreaders for the same work, and a short deadline.

CONCLUSIONS

The technical proofreading done by a group of nurses contributed to the accuracy and comprehension of the original work, allowing professional growth and the development of research in the area. The formation of a proofreading group, with no more than five professionals; discussions prior to, during, at the end of the task; consultation with experts in linguistics and in specific content areas, as well as with the author when necessary; the search for the vocabulary equivalence; and stimulation of scientific works in the technical proofreading area are all advisable strategies.
Evaluation of Altered Urinary Elimination in Patients With Chronic Renal Insufficiency
Authors: Barbosa Dulce Aparecida , Barreto Genia Pithon , Carminatte Deise Aparecida , Ramos Lea Luccas , Bettencourt Ana Rita
Published: August 2004

PURPOSE

To identify the defining characteristics and related factors of altered urinary elimination in patients with terminal chronic renal insufficiency.

METHODS

Physical and clinical evaluations were carried out in order to identify altered urinary elimination, its defining characteristics and related factors using NANDA's theoretical referents. The study included hospitalized patients in the nephrology unit of a hospital in São Paulo, Brazil.

FINDINGS

A sample of 50 patients (22 males, 28 females) with end‐stage chronic renal insufficiency were evaluated; mean age was 44 years (range: 15–81); mean hospitalization time was 12 days (range: 2‐37). Altered urinary elimination was diagnosed in 26 (52%) patients. The defining characteristics compatible with NANDA's list were urinary frequency (observed in 24 patients; 92%) and dysuria (in 8 patients; 23%). Related factors were multiple causes in 25 (96%) patients and motorsensory disorders in 7 (26%) patients; infection was seen in 3 (12%) patients.

CONCLUSIONS

NANDA's theoretical referents, considered indicators of defining characteristics, and related factors were very relevant when accurately diagnosing altered urinary elimination.
Mixed Incontinence in Women: A New Nursing Diagnosis
Authors: Baena de Moraes Lopes Maria Helena , Higa Rosângela
Published: August 2004

PURPOSE

To substantiate the nursing diagnosis of mixed incontinence and demonstrate the need for its acceptance.

METHODS

Interviews with 148 women with complaints of urinary incontinence. Initial diagnoses were identified and these cases later discussed with a specialist in nursing diagnosis in order to reach a consensus.

FINDINGS

Fifty women (34%) had stress urinary incontinence, 13 (9%) had urge incontinence, and 85 (57%) presented with characteristics specific to two types of incontinence (i.e., mixed incontinence). The age range of the women who presented mixed incontinence was 26–85 years (mean age: 49.16 ± 12.02 years); all reported stress urinary loss and a perception of urinary urgency. More than 50% of the women reported nocturia, increased urinary frequency, dribbling with increased abdominal pressure, inability to stop or start miction, inability to reach toilet in time, and inability to completely empty bladder.

DISCUSSION

The high frequency of mixed incontinence (57%) in this study may be a function of the complexity of these cases.

CONCLUSIONS

The evidence found in medical and nursing literature indicates the need to include mixed incontinence as a nursing diagnosis. It is considered to be quite frequent in women with urinary incontinence and is generally more frequent than urge incontinence. Patients may receive inadequate treatment if this diagnosis is not recognized.
Evaluation of Proposed Interventions for Fatigue in Patients Hospitalized With Congestive Heart Failure
Authors: Cinthia Calsinski de Assis  , Leite de Barros Alba Lucia Botura
Published: August 2004

PURPOSE

To evaluate the results of applying NIC interventions and NOC outcomes for fatigue.

METHODS

The study population comprised 30 patients with congestive heart failure (CHF) hospitalized for treatment in Hospital São Paulo in Brazil. They were followed from the day of hospitalization to hospital discharge. NIC interventions for each nursing diagnosis were evaluated daily on an evaluation scale.

FINDINGS

After application of NIC interventions and NOC outcomes, patients progressed satisfactorily. On day 1 of hospitalization, only 17% of patients had a score of 5 (normal) for the skin color indicator; by day 7, 43% had achieved this score. With regard to “reported activities of daily living performance,” no patient had a score of 5 on day 1 of hospitalization, and by day 7, 23% of the patients scored 1 (very impaired).

CONCLUSIONS

NIC interventions satisfactorily achieved the expected NOC outcomes.
Validation of Priority NIC Interventions and Suggested NOC Outcomes for Fluid Volume Excess
Authors: de Lima Lopes Juliana , Leite de Barros Alba Lucia Botura
Published: August 2004

PURPOSE

To identify and evalutate NIC priority interventions performed by Brazilian nurses and the associated NOC outcomes for patients whose clinical conditions suggest fluid volume excess.

METHODS

An exploratory study was developed in two phases: (a) validation of the content of the priority NIC interventions and suggested NOC outcomes by seven expert nurses from a cardiology ward and the researcher, and (b) activities and indicators chosen were performed and evaluated daily for all patients admitted to the cardiology ward whose clinical conditions suggested fluid volume excess.

FINDINGS

Nurses chose 26 activities from the NIC categories of “fluid management,” 23 from “fluid monitoring,” and 28 from “hypervolemia management.” Eighteen NOC outcomes were chosen from Fluid Balance, 11 from Hydration, and 13 from Electrolyte and Acid/Base Balance.

CONCLUSIONS

Nurses identified many NIC activities that are important to their practice, and they also agreed with many NOC indicators. The use of standardized languages for interventions and outcomes will allow them to develop the process of nursing care and to establish practice standards.
Using Caretracker to Validate NOC Scores
Authors: Jenkins Peggy
Published: August 2004

BACKGROUND

Thirteen residents of a long‐term care facility participated in a study on the use of caretracker, a system to use “real time” data to code the minimum data set by tracking activities of living and providing supportive documentation.

MAIN CONTENT POINTS

With the caretracker data, more individualized care plans were produced and modified. Nursing interventions could be seen to facilitate the desired outcomes based on the behavior‐monitoring forms and the caretracker entries. This, in turn, validated the NOC scores.

CONCLUSIONS

Caretracker data can be used to support nursing efforts and patient outcomes.
Use of NANDA‐ and NIC‐Based Nursing Care Plans in Public Health Nursing Practice
Authors: Rivera Jennifer C. , Parris Kathleen M.
Published: August 2004

PURPOSE

To evaluate selected nursing diagnoses and interventions for their capacity to accurately document public health field nursing (PHFN) practice; to describe the most common nursing diagnoses and interventions used by public health nurses.

METHODS

A retrospective review of family charts was conducted to analyze the use of nursing diagnoses and interventions.

FINDINGS

The frequency pattern of nursing diagnoses and nursing interventions used in care plans is consistent with the scope of public health nursing practice, whose emphasis is on health promotion and disease prevention.

DISCUSSION

These commonly used diagnoses and interventions provide evidence of a core set of interventions useful for practice in public health. In addition, linking the NANDA diagnoses and the NIC interventions revealed that public health nurses have an inventory of frequently used interventions that crosses visit type and nursing diagnoses.

CONCLUSIONS

Identifying the use rate of particular diagnoses and interventions will help determine which diagnoses and interventions should be included in the PHFN electronic medical record. Also, linking diagnoses and interventions will allow PHFN to build a body of knowledge based on actual patient care and, ultimately, to assist public health nurses to make better clinical decisions.